Facelift

Alternative names
Rhytidectomy; Cosmetic surgery of the face

Definition

A facelift is a surgical procedure to repair sagging, drooping, and wrinkled skin of the face and neck. It is performed to improve visible signs of aging, poor diet, or heredity; it is performed by removing excess fat, tightening underlying muscles, and redraping facial and neck skin.

Description

Sagging or wrinkled skin occurs naturally with increasing age. Folds and fat deposits appear around the neck, and deep flexion creases form between the nose and mouth. The jawline grows “jowly” and slack. Heredity, poor diet, smoking, or obesity may contribute to early or severe skin problems.

A facelift can help repair some of the visible damage to skin, fat, and muscles and can restore a “younger” look. A facelift can be done alone or with nose reshaping, a forehead lift, or eyelid surgery.

While the patient is sleepy (sedated) and pain-free (local anesthesia) or deep asleep and pain-free (general anesthesia), the plastic surgeon makes incisions above the hairline at the temples, behind the earlobe, to the lower scalp.

The surgeon removes some of the fat tissue and loose skin, then stitches (sutures) the incisions closed. The fat tissue is called the SMAS layer and is the primary lifting portion of the facelift.

Indications
Dissatisfaction with facial signs of aging and otherwise good health.

Risks
Risks for any anesthesia are:

     
  • reactions to medications  
  • problems breathing

Risks for any surgery are:

     
  • bleeding  
  • infection

Additional risks include:

     
  • a pocket of blood under the skin (hematoma) that may require drainage  
  • injury to nerves that control facial muscles (usually temporary)

Expectations after surgery
Most patients are pleased with the results.

A small, thin drainage tube may be temporarily placed under the skin behind the ear to drain any blood that might collect there. The head is wrapped loosely in bandages to minimize bruising and swelling. Usually there is not much discomfort after surgery and pain medication can relieve it. Some numbness of the skin is normal and will disappear in a few weeks or months.

The head will be elevated on two pillows (or at a 30 degree angle) for a couple of days after surgery to keep the swelling down. The drainage tube will be removed 1 to 2 days after surgery if one was inserted. Bandages are usually removed after 1 to 5 days. The face will look pale, bruised, and puffy, but in 4 to 6 weeks it will be looking normal.

Most of the stitches will be removed in 5 days. The stitches or metal clips in the hairline could be left in a few days longer if the scalp takes longer to heal.

Convalescence

The patient should expect swelling, bruising, skin discoloration, tenderness, and numbness for 10 to 14 days. Most of the surgical scars are hidden in the hairline or the natural lines of the face and will fade over months. Sun exposure should be limited.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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