Rhytidectomy, or facelift, is a surgical procedure to improve the signs of aging in the face and neck. According to recent statics by the American Society of Plastic Surgeons, it is the fifth most common cosmetic surgery procedure. Aging in the face and neck results from the effects of gravity and loss of volume over time. These signs of aging often include loss of skin elasticity, sagging in the mid-face, the formation of jowls, and loose skin and excess fatty deposits under the chin that can produce the appearance of a double chin.
Depending on the changes that you and your plastic surgeon discuss, your surgical choices include a traditional facelift, a limited incision or mini facelift, or a neck lift. There are multiple variations in each procedure, and is up to you and your plastic surgeon to choose the one that is best for you during your consultation process. The traditional facelift utilizes incisions that extend from the temples, down in front of the ears and around the earlobe to hairline. Often the incision is extended from behind the ears into the hairline. This incision allows elevation of the sagging face, refinement of the jaw line, and tightening of the neck. Fat grafting may be done at the same time as the facelift to restore volume in key areas of the face. An additional incision is often placed under the chin to allow tightening of muscles and removal of excess fat. The goals of surgery are to produce a more youthful appearance through repositioning the deeper layers of the face and removing excess skin.
A traditional facelift is the most encompassing of the procedures available. It addresses the sagging mid-face, jowls, and neck. A limited incision or mini facelift allows for correction of mild to moderate signs of aging through an incision that is much less extensive. This incision is often limited to the front of the ear and to a lesser extent behind the ear. A mini facelift helps elevate the sagging face and refinement of the jaw, but is not as comprehensive for improving the aging neck.
After your consultation you should have a clear understanding of the different treatment options for improving the appearance of your face and neck as well as any other areas such as your forehead and eyes. The selection of a specific procedure will be determined by your physical examination and expectations.
The physical exam will include assessments of skin quality and excess, fine and deep lines/wrinkles, and descent and/or loss of facial fat volume. Then neck will also be evaluated for excess skin, excess fat deposits, and position of the muscles. The patient’s hairline will also be evaluated, specifically at the sideburn area, as this may determine if the facelift incision is hidden within the hair or if it will course in front of the hairline.
Following your surgery, bandages and a light wrap will be applied to your face and head. Small drains may be placed temporarily to drain any excess fluid or blood that may collect. You will be given specific instructions on how to care for your incisions and drains.
The immediate recovery will depend upon what type of anesthesia that your plastic surgeon will employ for the surgery. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. Most surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in 3-4 hours and most patients will experience mild to moderate discomfort at this stage that is well controlled with pain medication prescribed by your doctor.
Patients should avoid strenuous exercise for 3 weeks following surgery. Patients may shower the following day; but no Jacuzzi, swimming or soaking in the tub for a week. Most plastic surgeons want to see their patients back in the office 5-7 days after their surgery to remove the drains which may have been placed at the time of surgery as well as to remove any sutures that do not dissolve on their own.
Healing time is highly variable, but most patients’ experience moderate swelling and some bruising that can persist up to 2 weeks. One of the potential risks of surgery is infection and this usually manifests itself around 5-7 days after surgery and is usually effectively treated with oral antibiotics. Numbness around the incisions is normal after surgery and can persist up to several months. The actual “full” recovery period from surgery is up to a year and this involves a gradual softening and settling of the scars and tissues. A significant amount of the recovery occurs within 2-3 months, but it will take the external scars up to a year to fully mature.