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Rhytidectomy (Facelift)


Technically known as a rhytidectomy, a facelift is a cosmetic procedure that usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient’s face and neck, with the purpose of giving a more youthful facial appearance. There are multiple surgical techniques and they can effectively be combined with eyelid surgery (blepharoplasty) and other facial cosmetic procedures. Facelifts can improve visible signs of aging in the face and neck, such as:

  • deep creases below the lower eyelids
  • deep creases along the nose extending to the corner of the mouth
  • fat that has fallen or is displaced
  • loose skin and excess fatty deposits under the chin and jaw
  • loss of muscle tone in the lower face

Keep in mind that, as a restorative procedure, a facelift does not change your fundamental appearance and cannot stop the aging process.


Facelift Procedures

There are many different procedures of rhytidectomy, and the differences are mostly the type of incision, the invasiveness and the area of the face that is treated. Surgeons can practice:

  • composite facelift
  • deep-plane facelift
  • MACS facelift
  • mid face-lift
  • mini-facelift
  • skin-only facelift
  • SMAS lift
  • subperiosteal facelift
  • thread lift

The SMAS (Superficial Musculo Aponeurotic System) layer consists of suspensory ligaments that encase the cheek fat. Through resuspension and securing the SMAS anatomical layer, surgeons can counteract aging and gravity caused by laxity, giving the face a rejuvenated look. Modifications to this technique led to the development of the composite facelift and deep-plane facelift. The deep-plane facelift was developed as to correct the deepening of the nasolabial fold more accurately. Although this technique has a higher risk at damaging the facial nerve, some surgeons believe the nasolabial fold is better addressed by a deep-plane or composite facelift.

During a composite facelift, a deeper layer of tissue is mobilized and repositioned. The mid-area facelift is recommended for people without a significant degree of jowling or sagging of the neck, and the ideal candidates are people in their 40s, or if the cheeks appear to be sagging, and the nasolabial area has laxity or skin folds. The surgeon will make several small incisions along the hairline and inside the mouth, lifting the fatty tissue layers and repositioning them. The fatty layer that lies over the cheekbones is also lifted and repositioned, improving the nose-to-mouth lines and the roundness over the cheekbones.

The mini-facelift is the least invasive type of facelift, similar to a full facelift but without involving a neck lift. Also called the “S” lift because of the shape of the incision, this procedure is a more temporary solution to the ageing of the face, with a less downtime. It is recommended for people who have deep nasolabial folds and sagging facial structures. The mini lift can be performed with an endoscope, used to reposition the soft tissues.

The thread lift is a minimally-invasive procedure, often used for people who seek minor improvements to treat sagging or laxity in the eye, nasolabial fold areas and forehead. It is performed under local anesthesia and the surgeon uses a barb suture technique. No skin is cut away, and the thread plus the barbs being the only things keeping the lift in effect.

During the subperiosteal facelift, soft tissues in the face are vertically lifted and completely separated from the underlying facial bones, elevated to a more esthetically pleasing position. The procedure can be combined with other standard techniques and can be done in all age groups. The disadvantage is that this procedure has a longer period of facial swelling, unlike the other lifts.

The skin-only facelift is not as technically demanding as the SMAS or other types of lifts, as only the skin of the face is lifted and not the underlying muscles, SMAS and other structures. Usually the lift re-sags within 6 to 12 months after the procedure. The MACS facelift stands for Minimal Access Cranial Suspension lift, and allows for the correction of sagging facial features through a minimal incision, elevating them vertically by suspending them from above. The procedure lasts about 2.5 hours and has a shorter recovery period of 2-3 weeks. The results are very natural and there is less risk of bleeding and nerve damage because less skin is raised.


Facelift Surgery Steps

After you have been anesthetized, the surgeon will begin the incision in the area of the temple hair, just above and in front of the ear, continuing under the earlobe and following the back of the ear, blending into the hairline. The incisions are aligned to accommodate natural lines and are placed where they fall in a natural crease of the skin for better camouflage. Next, the surgeon gently lifts the skin, repositioning and tightening the underlying muscle and tissue. Fat and excess skin may be removed. Fine sutures and metal clips are used for closing the incisions after trimming the excess skin.

Depending on the extent of the surgery, the process can take from 2 to 4 hours. Following your surgery, the doctor will apply a dressing to protect the area where the incisions have been made. It is extremely important to follow your surgeon’s advice on how to care for and handle the bandage.


Risks and Safety

The most common complication can be bleeding, which usually requires a return to the operating room. Less common, complications may include damage to the facial nerves and necrosis of the skin flaps or infection. Other complications which may arise include:

  • unfavorable scarring
  • poor wound healing
  • skin loss
  • fluid accumulation
  • persistent pain
  • skin contour irregularities
  • facial asymmetry
  • hair loss at the incisions
  • fat necrosis
  • changes in skin sensation

If you experience shortness of breath, chest pains, unusual heart beats and general discomfort, seek medical attention immediately. Tightness, numbness and subtle swelling will possibly last several months. You should contact a doctor immediately if:

  • you have a fever of 100 degrees or more
  • you experience abnormal discharge from the incision site
  • you have bleeding that saturates the dressing
  • you have extreme swelling associated with pain and pressure
  • you have sutures coming out before you are due to have them removed


Preparing for Consultation and Surgery

The success and safety of your procedure depends very much on your candidness during the initial consultation. You will be asked a number of questions about your health, lifestyle and desires. The surgeon will ask you about the reasons you wish to receive a facelift, your expectations and desired outcome. It is important to let your surgeon know about your medical conditions, drug allergies and medical treatments. If you are currently using medication, taking vitamins or herbal supplements, you will need to inform the medical staff. Also, the surgeon needs to know about your alcohol, tobacco and drugs intake, as well as previous surgeries.

During your consultation and based on the information you provided, the surgeon will evaluate your general health status and any pre-existing health conditions or risk factors, which may interfere with your surgery. You will discuss the options available to you for your facelift, and after the surgeon examines and measures your face, he or she will take photographs for your medical record. The surgeon will then recommend a course of treatment after presenting you the options and likely outcomes. You will also be informed about the risks and potential complications, along with the type of anesthesia that will be used.


Am I a Candidate for a Facelift?

Apart from good health and realistic expectations, which are prerequisites, facelift candidates should also understand the limitations of the facelift and be psychologically stable. There is no ideal in a facelift, and the goal is to improve the overall facial appearance. Facelift surgery is a good option for people who:

  • are physically healthy
  • do not smoke
  • have a positive outlook and specific, but realistic goals in mind for the improvement of their appearance

Candidates should know that a facelift does not stop aging, but rather helps turn the clock backwards to restore a more youthful appearance.

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