A facelift, or rhytidectomy, is a procedure in cosmetic surgery that aims to give a more youthful appearance to the face.

It reshapes the lower half of the face by removing excess facial skin.

Rhytidectomy can tighten loose, hanging skin around the jaw line, also known as “jowls.” It can also remove deep creases around the mouth and nose, and excess, hanging skin and fat under the chin and in the neck.

The procedure can also tighten the underlying tissues, and it may be combined with surgery to enhance the forehead, cheeks, brows, and eyelids.

In the United States, 107,261 women and 13,702 men had surgery for a facelift in 2016. Among men, it was the fifth most common type of aesthetic surgery.

 

What is a facelift?

[facelift]
A facelift removes excess facial skin.

Facelift surgery is usually done as an outpatient procedure. It may involve a local anesthetics and sedatives or general anesthesia.

The procedure can take from 2 to 5 hours, and the person can normally go home on the same day after surgery.

In a traditional facelift, the surgeon makes an incision in front of the ear, extending up into the hair or hairline as well as behind the ear into the hair-bearing scalp.

The surgeon lifts the skin off the deeper facial muscles and fat, gently pulls the skin in an upward and posterior direction, and removes the excess skin. They may tighten the deeper tissues of the face.

A small incision, or cut, may be made under the chin to tighten the skin and deeper tissue of the neck. This is known as a neck lift.

The incisions are then closed with sutures and possibly staples. A drain may be placed under the skin behind the ear for one or two days, to remove any excess blood and fluids. Bandages are applied.

What to expect

Before surgery, the plastic surgeon will review the patient’s medical history.

They will look at:

  • blood pressure
  • blood clotting
  • medications
  • cigarette smoking
  • drug use
  • allergies
  • scarring
  • skin condition

The doctor and patient will discuss what the surgery will involve, where it will take place, the type of anesthesia used, the recovery, and potential complications that may develop.

They should also examine the goals and expectations of the surgery, according to the skin type and bone structure.

New surgical techniques

New methods are continually being developed to improve cosmetic procedures. Many of these procedures claim to make recovery faster and easier, but they are often modifications of a traditional facelift.

Lasers are sometimes used for a neck-lift procedure called laser neck and jaw liposculpture and resurfacing.

The work is often carried out under a local anesthetic, through a one-inch incision under the chin. The laser is used to melt some of the fat under the chin and to tighten the skin while it heals in a more lifted manner.

Endoscopy may be used in face and brow lifts. Using small cameras allows for smaller incisions. This means less trauma to tissues and a faster recovery time.

Forehead skin can be raised through small incisions in the frontal hairline. It is then lifted and secured to the deeper tissues to prevent further sagging or drooping.

Liposuction can remove focal deposits of fat in the face, usually between the chin and the neck. It can be done as part of a facelift, or as a separate procedure.

A mini-facelift is a less invasive procedure that also aims to lift the wrinkles and sagging skin in the lower part of the face. Because it involves a smaller, s-shaped incision around the ear, it cannot address neck sagging or excess skin.

Scarring and recovery time may be shorter than in a traditional facelift.

People often combine a facelift with eyelid surgery and other facial procedures.

Is it worth it?

A facelift aims to create a smoother, more youthful appearance.

The procedure:

  • removes and tightens sagging skin
  • reduces the droop of the cheeks around the jaw line
  • lifts the corners of the mouth
  • reduces the creases between the cheeks and the lips

The incisions in front of and behind the ear are usually not noticeable.

However, there can be some disadvantages.

A facelift does not last forever.

Research suggests that five and a half years after surgery, 21 percent of facelifts relapse, but that 76 percent of people still look younger than they did before the operation.

In men, it can be harder to achieve a natural appearance after surgery, because they have hair in front of their ears, or sideburns. If the sideburns are pulled backward and upward, this can look odd.

In both men and women, a facelift can lead to distorted earlobes.

If too much skin is removed, the face can look pulled-back or startled.

For the best results, a person may need additional procedures, such as a neck lift, eyelid surgery, liposuction, fat injection, removal of cheek fat, forehead lift, brow lift, chemical or laser peel, and cheek or chin implants.

A facelift is expensive. The average cost for a facelift in the U.S. in 2016 was $7,503. It is not normally covered by insurance.

Complications

Complications of facelift surgery are infrequent, and cosmetic procedures are generally safe, as long as they are carried out by a qualified and experienced professional.

However, any surgery comes with some risk.

The risks and complications of facelift surgery include:

  • Bleeding
  • Bruising
  • Complications of anesthesia
  • Damage to the facial nerves controlling muscles, usually temporary
  • Hematoma
  • Infection
  • Loss of hair around the incision site, but this is uncommon
  • Numbness, which can improve within days or weeks
  • Scarring
  • Skin necrosis, or tissue death
  • Unevenness between two sides of the face
  • Widening or thickening of scar

If the patient notices inflammation, pain, redness or swelling in the days following surgery, they should seek medical help. This could be a sign of hematoma. If there is a fever, they may have an infection.

Recommendations

However, the following points should be discussed and considered before going ahead:

  • Facelift surgery is not recommended for anyone with serious medical problems, and the candidate should be in good mental and physical health.
  • Patients with high blood pressure and diabetes have a higher risk of complications.
  • Cigarette smoking and tobacco use increase the risk of complications after surgery. It can interfere with wound healing. A person who is considering a facelift should completely stop smoking or using nicotine products.
  • It is important to have reasonable expectations and to remember that a facelift will not stop the overall aging process.
  • Good skin elasticity and bone structure will give the best results.
  • Patients should not use taking aspirin or other blood thinners for at least a week before surgery.

It is important to have realistic expectations when undergoing cosmetic surgery. The results are often permanent.

Recovery

Most patients experience some discomfort, but medication can relieve tenderness.

Bruising and swelling will be at their worst after 2 days, and they can persist for a few days.

Recovery normally takes around 2 weeks, and vigorous activity can resume after 4 weeks.

Sutures are removed about 5 to 10 days after surgery.

Incisions and bandages must be kept dry, and the patient should follow the specific instructions about bathing and washing.

It is important to follow the doctor’s instructions, as this will speed the healing process and allow for the best possible result.

Numbness and muscle stiffness is normal for some time. Scars can take nearly a year to fade and tone down.

It is worth remembering that while genetics play a role, a healthy lifestyle with a balanced diet and sufficient exercise can also help to maintain the appearance of the skin.

Avoiding smoking and limiting alcohol intake, stress, sun exposure, and contact with pollutants can all help extend the youthful appearance of skin.

The same habits can help maintain the effects of facelift surgery.