Facelift

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

Alternative Names

Rhytidectomy; Facialplasty; 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 that begin above the hairline at the temples, extend behind the earlobe, and to the lower scalp. Often, this is one cut. An incision may be made beneath your chin.

Many different techniques exist. The outcomes for each one are similar.

During a facelift, the surgeon may:

Remove and "lift" some of the fat and muscle 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

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Why the Procedure is Performed

Sagging or wrinkled skin occurs naturally as you get older. Folds and fat deposits appear around the neck. Deep creases form between the nose and mouth. The jawline grows "jowly" and slack. Genes, poor diet, smoking, or obesity can make skin problems start sooner or get worse faster.

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

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

Risks

Risks of anesthesia and surgery in general are:

Reactions to medicines
Breathing problems
Bleeding, blood clots, or infection

Risks of face lift surgery include:

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

Although most people are happy with the outcomes, poor cosmetic results that may need more surgery include:

Unpleasant scarring
Unevenness of the face
Fluid that collects under the skin
Irregular skin shape (contour)
Changes in skin color
Sutures that are noticeable or cause irritation

Before the Procedure

Before your surgery, you will have a patient consultation. This will include a history, physical exam, and a psychological evaluation. You may want to bring someone (such as your spouse) with you during the visit.

Feel free to ask questions. Be sure you understand the answers to your questions. You must understand fully the preoperative preparations, the facelift procedure, and the care after surgery.

Before the day of surgery, you may have blood drawn and be asked to provide a urine sample. This allows the surgeon to rule out potential complications. If you are not hospitalized, you will need a ride home after the surgery.

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 reduce bruising and swelling.

You should not have much discomfort after surgery. You can relieve any discomfort you do feel with pain medicine the surgeon prescribes. Some numbness of the skin is normal and will disappear in a few weeks or months.

Your head needs to be raised on 2 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 to 2 days after surgery if one was inserted. Bandages are usually removed after 1 to 5 days. Your face will look pale, bruised, and puffy, but in 4 to 6 weeks it will look normal.

Some 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

Follow instructions about using concealing makeup after the first week. Mild swelling may continue for several weeks. You may also have numbness of the face for up to several months.

Outlook (Prognosis)

Most people are pleased with the results.

You will have swelling, bruising, skin discoloration, tenderness, and numbness for 10 to 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 health care provider will probably advise you to limit your sun exposure.

References

Locke MB, Nahai F. Managing the cosmetic patient. In: Neligan PC, ed. Plastic Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 1.

McLain L. Facial cosmetic surgery. In: Hupp JR, Ellis E, Tucker MR, eds. Contemporary Oral and Maxillofacial Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 27.

Warren RJ. Facelift. In: Neligan PC, ed. Plastic Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 11.