Face lift surgery is a cosmetic procedure that involves redirecting some of the skin and muscle tissue of the face and neck to counter signs of aging produced by gravity.
Purpose
The purpose of face lift surgery, also known as facialplasty, rhytidoplasty, or cervicofacial rhytidectomy, is to improve the appearance of the face by repositioning the skin and tightening some of the underlying muscle and tissue. The procedure is designed to counter sagging and looseness in skin and muscle tissue caused by gravity as the patient ages. Face lift surgery will not erase all facial wrinkles, as the term rhytidectomy (which literally means "surgical removal of wrinkles") might imply. Wrinkles around the mouth and eyes, for example, may benefit little from face lift surgery. Other procedures, such as blepharoplasty, chemical peel, or dermabrasion, also may be necessary.
Precautions
Patients with other medical conditions should consult with their primary physician before undergoing face lift surgery. Lung problems, heart disease, and certain other conditions can lead to a higher risk of complications. Patients who take medications that can alter the way their blood clots (including female hormones, aspirin, and some non-aspirin pain relievers) should stop these medications prior to surgery to lower the risk that a hematoma will form. A hematoma, a pocket of blood below the skin, is the most frequent complication of face lift surgery.
Description
Face lift surgery can be performed on an outpatient basis with local anesthetics. Patients typically also receive "twilight anesthesia," an intravenous sedative that helps to lower their awareness of the procedure being performed.
There are a number of variations of face lift surgery. Which one is used will depend on the patient's facial structure, how much correction is needed, and the preferences of the surgeon performing the procedure. In a typical face lift surgery, the surgeon begins by making an incision within the hairline just above the ear. The incision continues down along the front edge of the ear, around the earlobe, and then up and behind the ear extending back into the hairline. The location of this incision is designed to hide any sign of the procedure later. The same procedure is repeated on the other side of the face. Using various instruments, the surgeon will then work to separate the skin of the face from its underlying tissue, moving down to the cheek and into the neck area and below the chin. Fat deposits over the cheeks and in the neck may be removed surgically or with liposuction at this time. The surgeon will then work to free up and tighten certain bands of muscle and tissue that extend up from the shoulder, below the chin, and up and behind the neck. If these muscles and tissue are not tightened, the looseness and sagging appearance of the skin will return. The surgeon then trims excess skin from the edges of the original incision, pulls the skin back, and staples or sutures it into place.
Preparation
Prior to the procedure, patients meet with their surgeon to discuss the surgery, clarify the results that can be achieved, and discuss the potential problems that can occur. Having realistic expectations is important in any cosmetic procedure. Patients will learn, for example, that although face lift surgery can improve the contour of the face and neck, other procedures will be necessary to reduce the appearance of many wrinkles. As mentioned
earlier, patients will stop taking aspirin, birth control or female hormones, and other medications affecting blood clotting about two weeks before the procedure. Some physicians prescribe vitamin C and K in the belief that this promotes healing. Patients will also be advised to stop smoking and to avoid exposure to passive smoke before the procedure and afterward. Some surgeons also recommend antibiotics be taken beforehand to limit the risk of infection. Some surgeons also use a steroid injection before or after the procedure, to reduce swelling.
Aftercare
After the surgery, a pressure bandage will be applied to the face to reduce the risk of hematoma. The patient may spend a few hours resting in a recovery room to ensure no bleeding has occurred. The patient then returns home. Some surgeons recommend that the patient remain reclining for the next 24 hours, consuming a liquid diet, and avoiding any movements that lead the neck to flex. Ice packs for the first few days can help to reduce swelling and lower the risk of hematoma. Patients continue taking an antibiotic until the first stitches come out about five days after the procedure. The balance are removed seven to 10 days later. Many patients return to work and limited activities within two weeks of the procedure.
Risks
The major complication seen following face lift surgery is a hematoma. If a hematoma forms, the patient may have to return to have the stitches reopened to find the source of the bleeding. Most hematomas form within 48 hours of surgery. The typical sign is pain or swelling affecting one side of the face but not the other.
Another risk of face lift surgery is nerve damage. Sometimes it can affect the patient's ability to raise an eyebrow, or distort his smile, or leave him with limited feeling in his earlobe. Most of these nerve injuries, however, repair themselves within 2–6 months.
Normal results
Some swelling and bruising is normal following face lift surgery. After these disappear, the patient should see a noticeable improvement in the contour of his face and neck. Some fine wrinkling of the skin may be improved, but deep wrinkles are likely to require another cosmetic procedure to improve their appearance.
Abnormal results
In addition to the risks outlined above, other complications of face lift surgery include infection, scarring, and hair loss near incision lines.
BOOKS
Asken, Saul. "Cervicofacial Rhytidectomy." In Cosmetic Surgery of the Skin: Principles and Techniques,ed. William P. Coleman. St. Louis: Mosby, 1997.
Tardy Jr., M. Eugene, and Mark Lingensmith."Face-List Surgery: Principles and Variations." In Roenigk and Roenigk's Dermatologic Surgery: Principles and Practice, ed. Randall K. Roenigk and Henry H. Roenigk. New York: Marcel Dekker, 1996.
Springer, Rachelle C. "Rhytidectomy: From Consultation to Recovery." Plastic Surgical Nursing, 16 (Spring 1996): 27-30.
ORGANIZATIONS
American Society for Dermatologic Surgery. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. <http://www.asds-net.org>.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. <http://www.plasticsurgery.org>.
Richard H. Camer
KEY TERMS
Hematoma—A complication of surgery in which a collection of blood forms below the skin.
Rhytidectomy—It literally means "wrinkle excision." It is another, misleading, term for face lift surgery.
Twilight anesthesia—An intravenous mixture of sedatives and other medications that decreases patients' awareness of the procedure being performed.
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