A classic face lift, also known as rhytidectomy, is used to turn back the hands of time, effectively lifting and tightening the contours of the face to give a more youthful appearance. Aging, excessive sun exposure, smoking, heavy drinking and drastic weight changes can all take their toll on the skin, weakening the connective tissues and diminshing elasticity to cause lines, wrinkles and lax skin.
Click on face and neck lift to read one patient's first hand account.
History of the Facelift
During a full facelift the skin is separated from the underlying tissue and pulled upwards and backwards, repositioning or removing the fat underneath and taking off the excess skin. From the 1980s it became popular to go a layer deeper during face lift surgery and tighten the underlying muscles of the face, the SMAS or platysmal layer. This layer of tissue and muscle is close to the skin - the SMAS (superficial musculo-aponeurotic system) - and is used by horses and other animals to twitch the skin.
In the 1990s some surgeons felt that going even deeper, into the layer adjacent to the bone, would be more effective, tightening all the layers of the face. Today most cosmetic surgeons perform a modification of these procedures and tailor the face lift surgery to the needs of the patient. Liposuction can also be used on the neck to produce a significant lift to the neck area.
How a Facelift is Performed
The type of face lift undertaken is dependant on the needs of the patient and then modified accordingly. The incisions are placed in a similar location for most patients. The cosmetic surgeon begins just above the ears and then comes along the creases in front of the ear. In many cases, especially in women, the incision is taken inside the middle third of the ear behind the protruding cartilage called the tragus.
This serves to hide the incision and makes it less noticeable. It is less common to do this in men because it can bring the hair bearing skin on to the ear. The incision then continues just below the earlobe and up and behind the ear. Some surgeons continue the incision horizontally into the scalp while others prefer to go along the hairline of the neck.
The skin of the face, or the skin and muscle, are then separated from the deep tissue.The amount of dissection and separation depends on the needs of the patient. It is common to extend the dissection within an inch (2.5cm) of the corner of the mouth. Some surgeons perform liposuction of the cheek, nasolabial fold or chin. The underlying muscle is then tightened either separately or in conjunction with the skin.
The tissue is then redrapped in its new position and the excess removed. The skin is closed with stitches, although some cosmetic surgeons use staples in the scalp area if being done in conjunction with a brow lift. Drains are sometimes used especially if there has been a significant bleeding.
Plastic and cosmetic surgeons vary as to whether they use bandages or not. These days it is common for none to be used but some surgeons will apply compression bandages for several days.
The operation is done under either local anaesthetic or general anaesthetic. It is often combined with other operations including eyelid tightening (blepharoplasty), neck lift and forehead lift or brow lift. Liposuction can also be used on the neck to produce a significant lift to the neck area.
Complications of Surgery
After all operations there is bruising and swelling. This lasts about two weeks but can continue for a month or more. Remember that the human body is asymmetrical and that even after surgery both sides of the body will look different.
All surgery requires an incision and therefore will leave a scar. In most patients the scar heals well, but in a small number of peopled the scar remains thick and heavy, especially behind the ear. At the time of surgery the small nerves that supply feeling to the skin are damaged. This may cause changes in sensation including numbness. Although uncommon, bleeding and infection are risks and can be serious. You will have pain and discomfort after this surgery. The pain usually only last for a few days. One per cent of all operations lead to major complications.
Making the Decision
You will need to weigh up the pros and cons and decide if it is right for you. This is a surgical procedure and as such carries with it potentially serious complications, which, although rare, include blood clot or embolus, even an unexpected response to drugs or anaesthetics can occur. Beside the complications that can develop after any surgery, there are problems that are specific to rhytidectomy surgery. These include damage to the nerves that provide feeling and movement to the face.
