The term rhytidectomy (or facelift) refers to a surgical procedure that improves the aging signs in the face and gives it a more youthful appearance.
As your age progresses, you lose the youthful appearance of your face because your skin becomes thinner, and you lose facial fat. Also, stress, hereditary, and smoking may play a role.
In rhytidectomy, the surgeon repositions (or removes) skin, fat, and muscles to reshape your facial contour. But, rhytidectomy is only cosmetic restorative surgery; it can’t change your appearance or stop the aging process.
It is one of the most common cosmetic surgeries. In the United States, more than 130,000 persons do it each year. It’s the 6th most popular after liposuctions, breast augmentation, breast lift, abdominoplasty, and blepharoplasty (eyelid lift).
But, it is an individualized surgery. It is individual to each face, and its results are also unique for each person. As with each surgery, it requires good preparation, depending on your condition. Discuss with your surgeon what the facelift can and can’t do. Ask about the benefits, risks, and possible complications. Ask him what you should expect and the expected results for your face.
Your surgeon can perform this surgery via various procedures; it depends on the used techniques, the targeted areas of the face and neck, and your preferences. Your doctor will discuss these procedures with you and choose the most suitable one. Most people undergo other cosmetic procedures with rhytidectomy, such as rhinoplasty and blepharoplasty.
Now, let’s dig deeper and discuss this surgery in detail.
What can the facelift do, and what can’t?
Each person -who gets older- experiences natural age-related changes in facial appearance. With age, your skin (involving that of the face) becomes looser and less elastic. Also, fat distribution in your body changes. It will increase in some areas and decrease in others, like the face. The facelift can restore (or reduce) some of these age-related signs and can’t correct others.
It can restore (or reduce):
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- The sagging appearance of the face and cheeks due to the relaxation of the skin
- The deep crease lines (or fold) that extend from the nose to the angle of the mouth
- Jowls, which are excess or drooping skin at cheeks or lower jawline
- The low (or disappeared) fat content
- Sagging skin and extra fat in the neck that makes the double chin appearance (the procedure should include a neck lift)
As we said before, it is just cosmetic restorative surgery. It can’t stop the aging process or change the whole appearance of your face.
It can’t treat:
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- The superficial wrinkles
- The creases around the nose and upper lips
- Sun damage
- Irregularities in the skin color
Who are the best candidates for the facelift?
Generally, you are a good candidate if:
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- You don’t have health problems that affect your body’s healing capacity.
- You are a non-smoker.
- You have well mental health, a positive outlook, and realistic expectations from this surgery.
As we said, this surgery is very individualized and unique for each person’s face. Don’t try to fit an ideal image or fulfill someone’s desires.
What are the possible risks and complications of this surgery?
As with all surgeries, the facelift may cause some complications, such as:
1. Hematoma
It is the most common complication. The blood collects under the skin, which causes swelling and pressure. It occurs within 24 hours of the procedure. Your doctor treats it by surgical evacuation to prevent damage to adjacent tissues.
2. Scarring
Incision of the facelift may cause permanent scars. But, the hairline, ears, and natural contour of the face usually conceal these scars. Rarely these scars may become red and raised. Your doctor may use local steroid injections to improve the appearance of these scars.
3. Nerve injury (like the facial nerve)
It is a rare but dangerous complication. An injury may affect the nerves controlling the facial sensations and expressions. The effect of this injury may be temporary or permanent. It may lead to loss of sensations or irregular facial expressions (or appearance). These effects may last up to a year. Your doctor may try some surgical interventions to correct this.
4. Sloughing (or skin loss)
The surgery may rarely interrupt the blood supply to the facial skin, which causes skin loss. Appropriate wound care and some medications may promote healing and prevent scarring. If necessary, a surgical procedure to minimize scarring may be performed.
As with any major surgery, persons who undergo a facelift are at risk of bleeding, infections, and anesthesia issues. Some people are at higher risk, such as smokers. Also, medications and medical conditions that affect blood clotting raise the risk of bleeding. Poorly controlled diabetes and hypertension also increase the risk of hematoma and poor wound healing (skin loss).
During consultation and preparation, your doctor will consider these risks and complications and your health condition to decide if this surgery is suitable. You and your doctor will consider the expected benefits and the possible risks.
5. Temporary or permanent hair loss
may occur at (or near to) the incision site. Transplantation of hair follicles may correct the permanent hair loss.
What should you know about the consultation of the facelift?
Facelift procedures and results are unique for your face and your condition. Thus, go through a detailed discussion with your surgeon before starting preparation for the surgery.
During the consultation visit, your surgeon will ask you:
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- Why do you want to do this surgery, and what do you expect from it?
- Do you have any health conditions or allergies?
- Do you take any medications (especially blood-thinning medications)?
- Did you have previous surgeries (plastic surgeries), and did you experience any complications?
- Are you smoking, drinking alcohol, using any drugs, or taking supplements?
After these questions, your surgeon will:
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- Evaluate your physical, psychological, and emotional health
- Examine and measure your face’s bony structure, shape, fat distribution, and skin quality
- Take your permission to take close-up photographs of your face and neck from different angles.
This discussion will give your surgeon comprehensive information to answer if the results will meet your expectations. Also, your surgeon will discuss the different facelift options with you and which one will suit your condition. He will also tell you which type of anesthesia that you will take.
Then, you and your doctor will weigh the probable outcomes versus the potential risks. This information aids your surgeon in planning for the surgery.
You should be aware of all aspects of the surgery that you will do. The consultation visit is the time to be curious and ask your doctor whatever you want to know. Ask your surgeon:
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- How long will the results last?
- Can I see pictures of my expected look after the surgery?
- What are the surgical techniques that you will use?
- How will the recovery occur, and when can I leave the hospital and return to work?
- What will happen if the results are not satisfying for me?
These questions and others will help you make the right decision regarding the surgery.
If you decided to do the facelift, how would you prepare for the surgery?
How would you prepare for the surgery?
You can do facelift surgery in a hospital or an outpatient surgical facility. During preparation, you should follow your doctor’s instructions. Your doctor may prescribe you certain medications or adjust your current medications. You may need to stop some medicines, like aspirin and other blood-thinning drugs, to reduce the risk of bleeding. Your doctor will inform you how and when to stop. Ask your doctor what is safe to take and at which dose. Also, your doctor may ask you to use certain products for your face.
Your surgeon will order some tests, like a blood test and coagulation profile, to check your fitness for the surgery. He would also consult a specialist if he had any concerns about your fitness due to any disease.
Stop smoking, alcohol drinking, taking recreational drugs before the surgery by enough time.
It isn’t a luxury to follow your doctor’s instructions. Follow his instructions to pass your surgery smoothly without healing problems or other complications.
Before the surgery:
Arrange for recovery:
Discuss with your doctor how long the recovery lasts. Then, plan for someone to drive you home and stay with you the 1st 48 hours after surgery. Establish a recovery area in your home before the surgery, and ask your doctor what you will need in recovery to prepare it.
On the night of the surgery,
You will stop eating anything after midnight. You can only drink water and take medications that your doctor prescribed and approved.
On the morning of the surgery,
Your surgeon will ask you to wash your face and hair with an anti-septic (germicidal) soap.
After preparation, how will the surgery pass (the steps)?
How will the surgery pass (the steps)?
1. Anesthesia
The surgery starts with anesthesia that aims to your comfort during the procedure. You can do the facelift under sedation and local anesthesia or general anesthesia. Sedation and local anesthesia numb only the part of your body where the surgeon performs the procedure. General anesthesia affects your consciousness, and you will go to sleep.
Your doctor will choose the best type of anesthesia, depending on your condition and the type of procedure that you will get.
2. During the procedure
The procedure begins by making an incision in the skin of your face. The surgeon has many options to do incision, as follow:
The traditional facelift incision:
The incision starts in the hairline at your template then continues around and in front of your ears. Then, it ends in the lower scalp behind your ear. Your surgeon may also do a small incision in your chin to improve the appearance of the neck.
This incision is for people who complain of moderate to significant aging signs and want optimal improvement.
The limited incision:
It is an alternative to the traditional incision and shorter than it. It begins in the hairline of your template (just above your ear) and continues in front of your ear. But, this incision doesn’t extend to the lower scalp as the traditional one.
This incision is for those with less skin sagging and aging signs, and its results are less rejuvenating than the traditional one.
The neck lift incision:
This incision starts in front of your ear lobe, continues behind your ears, and ends in the lower scalp. The surgeon will also make a small incision in your chin.
This incision triggers the sagging jowls, relaxed neck skin, and the accumulating fat under the chin.
The type and size of the incision depend on which type of facelift procedures you will undergo.
3. After the incision
The principal goal of rhytidectomy is to reshape the contour of your face. The surgeon elevates the skin and tightens the underlying supporting structures of your face and neck. Then, he will sculpt, remove, or redistribute the fat in your face to give you the desired (or expected) appearance. Finally, your surgeon closes the skin over the newly repositioned facial contour and removes the excess skin. This procedure is the traditional facelift procedure.
There are other procedures to do the facelift, as follows:
A) SMAS facelift:
SMAS abbreviation refers to the muscular layer of the face (superficial muscular aponeurotic system). In this procedure, your surgeon tightens your muscles and removes the excess skin in the lower two-thirds of your face and cheeks. It’s a variation from traditional surgery.
B) Deep plane facelift:
The surgeon elevates the skin, fat, and muscles as a single unit. Your surgeon uses this procedure to handle multiple areas of your face at the same operation.
C) Mid-facelift:
This procedure targets your face at the cheek area.
D) Mini-facelift:
This procedure targets the lower face and neck. It’s less invasive and quicker than the others. Surgeons recommend this procedure for younger people with early aging signs, like sagging.
Your doctor will discuss all of these various procedures and incisions with you. Together you will plan a surgery that suits your condition and meets your goals with the least possible risks. Generally, more aging signs require more significant surgery.
Many people undergo other plastic procedures at the same time as plastic surgery, such as:
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- Facial implants
- Brow lift
- Rhinoplasty (Nose job)
- Eyelid lift (blepharoplasty)
- Skin resurfacing with a laser
- Liquid facelift (with injectable dermal fillers)
- Chemical peel
- Jawline rejuvenation
The facelift usually takes about two to four hours, but it may last longer if you undergo other procedures at the same time.
4. After the procedure
your surgeon will close the incision with sutures that may be dissolvable or need removal by a surgeon. Some surgeons may use skin glues to close the incisions. After healing, the hairline will conceal the incision in the natural contour of your face and ear.
After the surgery, the surgeon takes you to a room for observation during waking up. It takes about two hours to be stable and to be able to leave the hospital.
You will have a bandage over your face to minimize swelling and bruising. Your surgeon may also place small drainage tubes to drain excess blood and fluids.
Before leaving the hospital, your surgeon will give instructions for your recovery period on:
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- care for the incision site, like applying cool packs to ease the pain and relieve the swelling
- how to deal with the drains
- which medications you should apply to the surgical site or take orally, like pain killers
- The red flags that you should give at the surgical concern at the surgical site and in your general health
- Schedule of the follow-up appointments
You left to your home; what should you expect during the recovery?
What should you expect during the recovery?
After the surgery, you will have swelling and bruising that takes about two to three weeks to disappear, while your face usually takes two to three months to feel it normal. Also, you may feel mild pain, numbness, and drainage from the incision. The healing period varies among people; some heal more quickly, while others heal slower. You should start to feel well in a few days.
Your surgeon will see you several times to:
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- remove the bandage in the first few days
- assess the swelling and bruising
- remove the stitches after the wound healing
When can you return to your work?
It depends on which type of facelift you had. An invasive facelift may need two to three weeks before returning to work. The less invasive procedures may require only five or seven days to return to work.
Your doctor will recommend avoiding stressful exercise in the 1st few weeks after surgery.
When should you see your surgeon immediately after the surgery?
Contact your surgeon (or healthcare provider) immediately if you experienced:
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- Fever
- Severe pain, especially on one side of your face and neck in the 1st 24 hours
- Extreme swelling or bleeding the full under the bandage
- Unusual discharge from the incision, like pus
- The stitches became loose before your doctor removed them.
When will you see the results of the facelift?
You will see a visible improvement after the swelling and bruising fade away. You won’t only get a more youthful facial appearance, but you will also get improved confidence and self-esteem.
Finally, rhytidectomy (or facelift) is cosmetic and restorative surgery with highly satisfactory results. But, you should have a good physical and mental condition to do it. Also, consider its risks before making a decision. Thus, talk to your doctor about your goal and expectations. Ask him about the possible complications. Together you will find the best option that meets your goals and be aware of all aspects of the surgery.