Facial plastic surgery

Facelift

A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of plastic surgery procedure used to give a more youthful appearance.

A facelift 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.

Before facelift		After facelift

Before facelift		After facelift

Before facelift		After facelift

Before facelift		After facelift

Facelift before		Facelift after

Facelift before		Facelift after
Facelift before		Facelift after
Facelift before		Facelift after

Facelift indication

Facelifts are helpful for eliminating loose skin folds in the neck and laxity of tissues in the cheeks. The areas not well corrected by a facelift include the nasolabial folds and perioral moundsmarionette lines which are more suitably treated with Botox or liposculpture, respectively.

Basic full facelift procedure (SMAS)

In the traditional facelift, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck.

After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck.

The incision for a facelift is made above the hairline and in front and behind the ear.

At this point of the facelift procedure, the deeper tissues (SMAS, the fascial suspension system of the face) can be tightened with sutures, with or without removing some of the excess deeper tissues.

The Superficial Musculo Aponeurotic System (SMAS) is an anatomical layer of thickened deep tissue and supsensory ligaments that encase the cheek fat pads and facial muscles and holds them in their normal position.

With aging and gravity, the cheek and the subcutaneous structures descend. Resuspension of these tissues by elevating and securing the SMAS is an integral part of a good facelift that lasts.

The skin is then redraped, and the amount of excess skin is removed. The skin incisions are closed with sutures and staples.

After dissection the skin is pulled upwards, the excess trimmed and the incisions are closed.

Recovery after a facelift

The physical recovery (as in discomfort and anaesthetic recovery) after a facelift is usually fairly mild and lasts for several days. It is well controlled with regular pain mediation.

As well there is an "appearance" recovery. Typically swelling and bruising should subside within 2-4 weeks. Final results of a facelift may be apparent in 1-2 months. Incision lines will continue to refine and fade for 1 year.

A chin support is used for the first weeks after a facelift to help mold the re contoured structures during the healing period.

A chin support is used for the first weeks after a facelift to help mold the re contoured structures during the healing period.

Complications

Early complications

There are risks involved in any form of surgery, and although these are uncommon, they cannot be ignored.

Infection after a facelift usually causes redness and inflammation near the incision. This can usually be treated with antibiotics, but occasionally may have to be drained. It can lead to delayed healing and increased scarring.

Bleeding after a facelift can cause a blood collection called a hematoma. If this is large enough it may have to be removed otherwise it can cause healing problems.

Delayed wound healing or skin loss can be caused by infection or bleeding after a facelift. It can also be caused by poor skin circulation. This is most common behind the ear. Secondary "touchup" surgery may be needed for this. It is more common in smokers, and for this reason it is recommended that smokers be smoke free for one month prior to surgery, or have a "mini" procedure.

Nerve related problems can result in numbness or weakness in the face after a facelift. This is usually due to swelling or stretching of the nerves and resolves. Rarely this can be permanent. It is normal to have some cheek or ear numbness after facelift surgery which usually resolves over three months.

Late complications

Hair loss may develop around the scars after a facelift.

Wide or thick scars are unusual and tend to occur behind the ears. They are more likely in dark skinned patients. These can usually be improved with "touchup" procedures.

Ear lobe deformities can occur as the tightened neck and cheek skin heals. These may benefit from a "touchup".

Skin color variation (darkening or reddening) can occur in some facelift patients due to abnormal personal healing characteristics.