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Rhytidectomy – Facelift

rhytidectomyA facelift (technically known as rhytidectomy) can’t permanently halt the ageing process, but it can “set back the clock,” improving the most visible signs of ageing by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.

The best candidate for a facelift is a man or woman whose face and neck have begun to sag. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties, as long as you are fit and healthy. A facelift can make you look younger and fresher, and it may enhance your self-confidence in the process. But it can’t give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Complications that can occur include haematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (this is temporary in 1 in 150 cases and permanent in less than 1 in 1000 facelifts, according to the plastic surgical literature), infection, and reactions to the anaesthesia. Poor healing of the skin (and even death of part of it) is most likely to affect smokers. Numbness of one ear occurs in about 1 in 100 facelifts.

You can reduce your risks by closely following your surgeon’s advice both before and after surgery.

Facelifts are very individualized procedures. In your initial consultation your surgeon will evaluate your face, including the skin and underlying bone, and your pattern of facial aging, and discuss your goals for the surgery.

He will check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell him if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

Your surgeon will explain the surgical techniques and anesthesia he will use, the hospital where the surgery will be performed, and the risks and costs involved. Don’t hesitate to ask your surgeon any questions you may have, especially those regarding your expectations and concerns about the results.

surgeryYour surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly.

If you smoke, it’s especially important to stop at least three weeks before and after surgery. Smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas. If your hair is very short, you might want to let it grow out before surgery, so that it’s long enough to hide the scars while they heal. Get your hair coloured before surgery as you won’t want to do so for some weeks afterward.

Changing your hairstyle radically after your surgery will help to disguise your recent facelift.

You should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.

Facelift surgery is sometimes done on an outpatient basis, under local anaesthesia and intravenous sedation. However considerable discomfort during this long procedure is the rule. General anaesthesia and an overnight hospital stay is preferred, you may decide to stay two or more nights.

A few facelifts are performed under local anaesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed. However, you may feel some tugging and occasional pain, as well as discomfort due to lying still for several hours.

Many surgeons including our surgeons prefer general anaesthesia. In that case, you’ll sleep through the operation.

A facelift usually takes several hours and somewhat longer if you’re having more than one procedure done.

Every surgeon approaches the procedure in his or her own way. The exact placement of incisions and the sequence of events depends on your facial structure and your surgeon’s technique.

Early facelifts simply pulled the skin tight, giving an unnatural “wind-swept” look to the face but taking only two hours or so to perform. Many “cosmetic clinic” general practitioners use these simple techniques. Modern plastic surgeons elevate the “SMAS” (fat and fibrous tissue) layer to correct jowling. Your surgeon uses an “extended SMAS flap technique”, as described by James Baker and Jim Stuzin of Miami, Florida. A “corset platysmaplasty” technique (as described by Joel Feldman of Boston) is used to reconstruct the neckline.

Incisions are hidden in the hair wherever possible. These usually begin above the hairline at the temples, extend in a natural line in front of the ear and just inside the cartilage at the front of your ear, and continue behind the earlobe to the scalp. If the neck needs considerable work, a small incision will also be made under the chin.

Your surgeon will separate the skin from the fat and muscle below. Fat is commonly trimmed or suctioned from around the neck and chin to improve the contour. Your surgeon will then tighten the underlying muscle and SMAS membrane, pull the skin back, and remove any excess. Stitches secure the layers of tissue and close the incisions, metal clips may be used in incisions hidden in the hair.

Following surgery, a small, thin tube will be temporarily placed under the skin behind your ear to drain any blood that might collect there. your surgeon will also employ an elasticized compression garment over your cheeks and neck to minimize bruising and swelling.

recoveryThere isn’t usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by your surgeon. (Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately.) Some numbness of the skin is quite normal, this will disappear in a few weeks or months.

Your surgeon will ask you to keep your head elevated and as still as possible for a couple of days after surgery, to keep swelling to a minimum. Ice packs applied frequently will also help to keep swelling and bruising to a minimum.

Your drainage tube will be removed one or two days after surgery. Don’t be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you’ll be looking normal.

Your stitches will be removed in stages over the first 7 to 10 days.

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first.

Your surgeon will give you more specific guidelines for gradually resuming your normal activities. Avoid strenuous activity, including heavy housework, for at least two weeks (walking and mild stretching are fine), limit your exposure to the sun for several months. Above all, get plenty of rest and allow your body to spend its energy on healing.

At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff, and you’ll probably be self-conscious about your scars. Some bruising may persist for two or three weeks, and you may tire easily. It’s not surprising that some patients are disappointed and depressed at first.

By the third week, you’ll look and feel much better. You may decide to take three to four weeks off work. Our nurse aestheticians can help you with makeup advice to cover any remaining bruising.

The chances are excellent that you’ll be happy with your facelift – especially if you realise that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places – behind the neck and ears where areas of beard-growing skin have been repositioned. This problem is easily adressed, once you are fully healed, using our state of the art hair removal laser.

You’ll have some scars from your facelift, but they’re usually hidden by your hair or in the natural creases of your face and ears. In any case, they’ll fade with time and should be scarcely visible.

Having a facelift doesn’t stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more time – perhaps ten years or more down the line. But in another sense, the effects of even one facelift are lasting – years later, you’ll continue to look much better than if you’d never had a facelift at all.

If you have further questions, write them down and ask your surgeon and his highly trained staff at your consultation.