Facelift

Definition

A facelift is a surgical procedure to repair sagging, drooping, and wrinkled skin of the face and neck.

Alternative Names

Rhytidectomy; Cosmetic surgery of the face

Description

A facelift can be done alone or with nose reshaping, a forehead lift, or eyelid surgery.

While you are sleepy (sedated) and pain-free (local anesthesia), or deep asleep and pain-free (general anesthesia), the plastic surgeon will make surgical cuts above the hairline at the temples, behind the earlobe, to the lower scalp. Often, this is a continuous cut.

Many different techniques exist, and the outcomes are similar.

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
• Tighten muscles
• Perform liposuction of the neck and jowls
• Use stitches (sutures) to close the cuts

Why the Procedure Is Performed

Sagging or wrinkled skin occurs naturally with increasing age. Folds and fat deposits appear around the neck, and deep creases form between the nose and mouth. The jawline grows "jowly" and slack. Heredity, poor diet, smoking, or obesity can contribute to early or severe skin problems.

A facelift can help repair some of the visible signs of aging. Fixing damage to skin, fat, and muscles can restore a "younger" look.

People who have a facelift are not satisfied with the signs of aging on their face, but are in otherwise good health.

Risks

Risks for any anesthesia are:

• Problems breathing
• Reactions to medications

• Bleeding
• Infection

Other risks include:

• A pocket of blood under the skin (hematoma) that may need to be drained
• Damage to the nerves that control muscles of the face (this is usually temporary)
• Wounds that do not heal well
• Pain that does not go away
• Numbness or other changes in skin sensation

Although most patients are happy with the outcomes, poor cosmetic results that may require additional surgery include:

• Unpleasant scarring
• Asymmetry of the face
• Fluid that collects under the skin
• Irregular skin shape (contour)
• Changes in skin color
• Sutures that become visible or cause irritation

After the Procedure

The doctor may temporarily place a small, thin drainage tube under the skin behind the ear to drain any blood that might collect there. Your head will be wrapped loosely in bandages to minimize bruising and swelling. You should not have much discomfort after surgery, and you can relieve any discomfort you do feel with pain medication. Some numbness of the skin is normal and will disappear in a few weeks or months.

Your head will be raised on two pillows (or at a 30-degree angle) for a couple of days after surgery to keep the swelling down. The drainage tube will be removed 1 - 2 days after surgery if one was inserted. Bandages are usually removed after 1 - 5 days. Your face will look pale, bruised, and puffy, but in 4 - 6 weeks it will look normal.

Most of the stitches will be removed in 5 days. The stitches or metal clips in the hairline might be left in for a few extra days if the scalp takes longer to heal.

You should avoid:

• Taking any aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) for the first few days
• Smoking and being exposed to secondhand smoke
• Straining, bending, and lifting right after the surgery

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.

Outlook (Prognosis)

Most patients are pleased with the results.

You will have swelling, bruising, skin discoloration, tenderness, and numbness for 10 - 14 days after the surgery. Most of the surgical scars are hidden in the hairline or the natural lines of the face and will fade over time. Your doctor will probably advise you to limit your sun exposure.

References

Baker SR. Rhytidectomy. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR. Otolaryngology: Head & Neck Surgery. 4th ed. St. Louis, Mo: Mosby;2005:chap 30.

Miller TR, Eisbach KJ. SMAS facelift techniques to minimize stigmata of surgery. Otolaryngol Clin North Am. 2007;40:391-408.