Introduction to Face Lift
A facelift, sometimes called a rhytidectomy, is a surgical procedure that lifts up the skin or underlying tissues of the face to reduce the visible signs of ageing.
What is a Face Lift (Rhytidectomy)?
A facelift, sometimes called a rhytidectomy, is a surgical procedure that lifts up the skin or underlying tissues of the face to reduce the visible signs of ageing. Our skin naturally becomes more elastic as we age, and the muscles in your face can become looser. This results in the development of some common signs of ageing, such as wrinkles and deep creases. Some of these can be improved with this procedure, resulting in a smoother, more youthful appearance.
It is important to take the time to seriously consider this type of surgery before deciding to have it, and it’s essential that you have a thorough consultation with the cosmetic surgeon prior to the procedure. You should discuss what you hope to gain from the surgery, and make sure you understand what is realistically achievable.
A facelift is most effective at removing wrinkles, creases and loose skin from areas of your face below the eyes, such as your cheeks, jaw and neck. Procedures that are often performed alongside a facelift include a brow lift and eyelid surgery. Together, these surgeries are more effective at reducing signs of ageing and restoring a youthful look to your face.
How is a Face Lift performed?
There are various different ways the procedure can be performed, but the surgery itself is usually conducted under a general anaesthetic. The traditional facelift involves an incision that begins just above the hairline at the temples, then continues down under the ear before ending back in the hairline on the lower scalp. Fat and underlying tissues can be redistributed before the skin is repositioned and stitched back in place. Sometimes a smaller incision will be sufficient, but it depends on the degree of change you would like to see.
How to prepare for a Face Lift?
Your surgeon will begin by taking many photographs of you and thoroughly examining your face. If you smoke you will be asked to stop prior to the procedure, as it can increase the risk of complications and slow down the healing process. If you are taking certain medications, such as those containing aspirin or non-steroidal anti-inflammatory drugs, then you will be told to stop around two weeks before the surgery. Your surgeon will discuss this in greater detail with you when he reviews what medications you are taking.
Closer to the actual date of the procedure you will receive specific instructions regarding what to do on the day, this will typically include having nothing to eat or drink for at least 6 hours before surgery.
What happens after a Face Lift?
For a short after the procedure your face will be wrapped in bandages to help control the short term bruising and swelling, but these are usually removed after one or two days. Although an overnight stay in hospital is sometimes recommended, it’s important that you have someone to help take you home if you are allowed to do so. As general anaesthesia can seriously impair your decision making and coordination, you should arrange for a friend or relative to stay with you for up to a day after the surgery. Your surgeon will tell you how long the stitches will take to dissolve if dissolvable stitches were used. Otherwise, non-dissolvable stitches are usually removed after a week.
The visible improvements of the facelift will become increasingly clear as the swelling subsides, a process that typically takes around two weeks. During this time, you will have to avoid any strenuous activity. Propping your head up when you lie down can help ease the swelling, and over the counter medications such as paracetamol and ibuprofen can be used if you require pain relief.
As with any surgery there are risks involved, and your surgeon will explain these to you in detail before the procedure. Some that are more specific to a facelift include: reduced hair growth on your temples and around your scars, an asymmetrical facial appearance or damage to the nerves in your face causing muscle weakness.
Will anyone know I have had a facelift (rhytidectomy) or, and a neck lift (platysmaplasty)?
With modern plastic surgery, facelift and neck lift procedures have advanced to the point where they are undetectable when done by a skilled plastic surgeon. For maximum rejuvenation, a facelift may be combined with surgery to the forehead, cheeks, brows, eyelids. A neck lift can also be combined with a facelift.
When the first face lifts were performed, they involved removing excess skin and then restitching it to make the skin smoother and tighter. Even in the hands of a skilled surgeon, a face lift would be noticeable and you would lose significant movement and expression in your features. New techniques now enable surgeons to lift the underlying muscles, redistribute fat and if required perform a neck lift to achieve a more balanced look.
Face and neck lifts are normally performed under a general anaesthetic; however, a mini face lift can be performed with a local anaesthetic and twilight sedation if requested.
What is a mini facelift or S-lift?
A mini face lift also called an S lift, in reference to the scar, lifts the skin and muscles in the lower portion of the face. An s-shaped incision is made behind the ear and the tissues and skin are cut and re-positioned. This type of face lift works well for anyone who feels they want to improve the contours of the face and address slack skin. Injectable treatments to fill in hollows or freeze wrinkles on the forehead and around the eyes, will often be combined with a mini face lift.
Full face lift (subcutaneous lift)
A full face lift will normally require an incision that starts at the earlobe and runs behind the ear and around the bottom of the scalp. Endoscopic techniques using small cameras can be utilised to allow surgeons to see without needing to make large incisions. The upper part of the face is lifted by making small incisions at the edge of the hairline along the forehead. The skin will then be raised and restitched to the deeper plane to hold it in place.
How is a suspension lift different to a full face lift?
A face lift with suspension incorporates internal sutures and, or mesh. An internal scaffold is created that further supports the tissues and muscles of the face in their new elevated position.
Is the SMAS lift better than a full face lift?
The SMAS (superficial muscular aponeurotic system) is a layer of tissue that can be separated and then re-positioned higher up. This method can be incorporated into both a mini-lift and a full face lift and gives a longer-lasting result. Not all surgeons recommend the SMAS lift due to the increased risk of damage to the facial nerves.
Composite Face Lift
During a composite face lift, the deeper dissection below the SMAS (superficial muscular aponeurotic system) enables the skin and underlying tissues to be re-positioned in one unit. This reduces the chance of causing nerve damage and the disruption of blood flow to the tissues which can result in necrosis.
Deep Plane Face Lift
The deep plane face lift, as the name suggests is the most invasive method and is used to lift the brow and cheek areas. This will often be performed during a second or third lift procedure and can be done using endoscopes (tiny cameras) to limit the size of incisions required.
MACS Face Lift
A MAC (Minimal Access Cranial Suspension) lift uses an incision in the front of the ear. Additional suspension sutures in the soft tissue lift the cheeks and further improves the definition of the jawline. The groves (nasolabial fold) that run down the side of the nose and lips are often a telltale sign of age are smoothed and tightened giving an overall appearance of a younger facial structure. The advantage is there is no need to separate the facial tissues from the muscles which makes nerve damage and other complications less likely.
Volume face lift
Subcutaneous tissue removed during the face lift is carefully positioned around the cheekbones (zygomatic arch) to give additional shape and structure. Liposculpture is performed to remove excess pads of fat under the chin. The fat can then be purified and injected into other areas of the face. Alternatively, dermal fillers can be used to balance the lifted area of the face and restore volume in areas where it has been lost due to age. Chin and cheek implants may also be inserted during a face lift to create the appearance of a stronger, younger bone structure.
How does a neck lift (platysmaplasty) work?
When a neck lift is required the Platysma muscles in the front of the neck are tightened by suturing them internally through a small incision underneath the chin. On occasion, a section of muscle may be cut away and lasers may be used to tighten the deeper layers of tissue following the excision of excess skin. In addition to smoothing and tightening the neck area, a neck lift will also help to create a more defined jawline.
What is a posterior neck lift?
A posterior neck lift is an option when there is not a significant excess of skin in the neck area. The advantage of this method is using only one incision along the bottom of the scalp, hidden just inside the hairline.
Risks of General Anesthetic
- Allergic reaction
Complications and risks of facelift and neck lift procedures
- Infection. Infection can result in skin death (necrosis)
- Hematoma. A hematoma, is a pool of blood that collects under the skin
- Scarring. Scars may be noticeable and there is always the possibility of keloid (thicker, darker) scars developing
- Nerve injury. Damage to nerves can result in changes to skin sensitivity and areas of numbness
- Distorted earlobes
How long will it take to recover from a face lift?
When a general anesthetic has been administered you may feel sick, cold and disorientated for between a few hours and a day. Occasionally memory loss and disorientation can last longer, although this is rare.
Your head will be bandaged and drains will likely be required which will be removed one to three days later before you leave the hospital.
Once home you will need to sleep in an elevated position with pillows under your shoulders for two to three weeks. You may have pain in your jaw and for a few days have been advised to only eat soft foods.
Bruising, swelling and general discomfort will continue to reduce over the next two to three weeks and most people are then able to return to work and daily activities. Strenuous exercise and heavy lifting should be avoided for a minimum of 12 weeks after the procedure.
Questions to ask prior to face lift and neck lift procedures
- Which procedure would you recommend I have and why?
- Will I need a general anesthetic?
- What type of procedures and how many have you done in the past 12 months?
- How many patients have had complications that required further surgery?
- What will you do for me if I am not happy with the results and will you charge for additional surgical procedures?