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Talksurgery adheres to the Health On the Net Foundation's Code of Conduct
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Face lift
(Rhytidectomy)
A facelift can tighten loose skin and muscle and remove excess fat to eliminate sagging. The best results are seen in the jowls and neck. A facelift may make you look younger but it cannot curb the ageing process. Depending on the condition of your face and skin, a facelift may improve but not eliminate the “laugh lines” between your nose, the corners of your mouth and/or the small vertical wrinkles around your lips. There are some things, however, a facelift cannot do like:
- smooth fine lines and wrinkles over your entire face
- remove deep horizontal creases in your forehead or vertical frown lines between your eyebrows
- remove signs of aging around the eyes, such as excess folds of eyelid skin, pockets of fat below the eyes and fine wrinkling of the eyelid skin.
Consequently, many facelifts are done in conjunction with other procedures including chemical peels, laser skin resurfacing, eyelid surgery, brow (forehead) lift, BOTOX® and collagen injections. Many patients also opt for liposuction to remove excess fatty deposits around the neck.
A modified facelift, referred to as a “minimal” or “mini” facelift, is a good option for younger patients who do not require as much correction. It is not only faster but less invasive which means reduced swelling, scarring, bruising and risk.
What does it cost?
The average cost in the US for simple rhytedectomy is about $5,500 but it can vary according to the individual surgeon and where he or she practices. In Canada, the cost can vary from $7,500 to $22,000 CDN depending on the extent of the procedure. Anesthesia and operating room facilities can cost an additional $1,000.
What happens during the procedure?
Your surgeon will begin with a complete medical history and examination to check for conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries, as well as an electrocardiogram.
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and the entire operation takes between 3 and 5 hours. For multiple or extensive procedures, your surgeon may chose to perform the procedures in two separate sessions. Most patients can return home after the surgery or can stay in a nearby hotel or recovery facility for the first night. Some, however, chose to remain in the hospital or in a recovery facility for a few days so that medical staff can monitor the recovery process.
Facelift surgery can be performed under local anesthesia mild sedation, under “twilight anesthesia” (which is local anesthesia with heavy sedation) or under general anesthesia. Usually long or multiple procedures are performed under general anesthetia. Before the surgery, your hair is held back with rubber bands on either side of your face. There is no need for your hair to be shaved, however, some hair near the incisions may need to be trimmed.
The incisions start above the hairline at the temples and continue along a line in front of the ear or just inside the cartilage at the front of the ear, behind the earlobe and back into the scalp. Another small incision is made under the chin for a neck lift. The surgeon separates the skin from the underlying fat and muscle. The muscles and sagging tissue are tightened and excess fat is removed. After the deep tissues are tightened, the excess skin is pulled up and back and then trimmed. The incisions are closed with stitches and/or with metal clips on the scalp. The surgeon then applies a dressing to protect the entire area where the incisions were made.
Although the scars are permanent, they fade over time and are hardly noticeable, as they are hidden either by your hair or the natural creases in your skin.
Are there risks or potential side effects?
As with any operation, there are risks associated with a facelift, such as infection, bleeding, hematoma, seroma, asymmetry and nerve damage. A certain amount of bleeding is unavoidable, which is why drains are inserted in the first two days.
Hematomas are collections of blood under the skin and, if small, can absorb spontaneously over several days. Drainage may be required for larger hematomas. Injury to the nerves that control facial muscles is usually only temporary. Some patients have reactions to the anesthesia and general anesthetic carries greater risks.
- Make sure to tell your surgeon if you are a smoker. Smoking can increase the risks of this procedure because nicotine constricts the blood vessels, decreases blood flow to tissues and greatly increases the chance of scarring. Skin sloughing is a common complication for facelift patients who smoke. In 10% of cases, patients who smoke can actually lose a portion of skin due to decreased oxygen flow into the skin caused by nicotine and decreased skin oxygen levels caused by carbon monoxide can cause the skin to die. These risks are significantly reduced if you stop smoking at least two weeks before surgery and wait until you are completely healed before starting again.
- Poor healing of the skin may also occur in people who have very thin skin. It is most likely to occur in the thin skin of the neck behind the ear.
What to expect post-procedure?
Following surgery, your entire face and neck is bandaged to minimize bruising and swelling. To drain any blood that might collect, a small drainage tube may be inserted under the skin behind your ear for a day or two. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above heart level when lying down. Your surgeon will advise that you avoid as much activity as possible in order to avoid tension on the scars, and to report any undue discomfort.
There is pain and discomfort for several days after surgery and your doctor will prescribe medication to alleviate it. Ice packs and cold-compresses will help reduce swelling and soothe pain but make sure the packs are not too heavy. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas.
Bandages are usually removed within 1 to 5 days and stitches can be removed after 5 days. Your scalp may, however, take longer to heal and complete healing of the scars can take up to a year. Some tightness and/or numbness of the skin can be expected, however, it will disappear in a few weeks.
It is not uncommon for patients to feel a bit depressed because facial features may be distorted from the swelling, facial movements may be slightly stiff and the bruising and scarring can make you self-conscious. You may look pale, bruised, and puffy at first, but in a few weeks the effects will be more visible.
How soon does normal life resume?
Your surgeon will give more specific guidelines for gradually resuming your normal activities and will suggest you take it easy the first week. Strenuous activities like heavy housework, exercise and should be avoided for at least two weeks. Once the bandages are removed you can shower and gently shampoo your hair. It is important to get lots of rest and to stay away from alcohol, steam baths, and saunas for several months.
Most patients are back to work within 2 or 3 weeks but major social engagements might be avoided for a month or sixeeks until you feel comfortable with your recovery. The hair around your temples may be thin and your skin may feel dry and rough for several months.
Bruising and scars can be camouflaged with make-up.
The results of a facelift are different according to the individual. Some people only ever have one facelift but others may have a second surgery 7 to 15 years later.
Who performs it?
A face lift is usually performed by a plastic surgeon or an otolaryngologist (ENT).
Are you a good candidate?
There is no such thing as a perfect or ideal facelift. Understanding the limitations of this procedure is crucial. Skin type, ethnic background, degree of skin elasticity, individual healing, basic bone structure, as well as a realistic attitude are factors that should be discussed prior to surgery. Most patients are between 40 and 65 but even people in their 70s and 80s undergo successful facelifts. As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to tighten the skin on your face and neck, then a facelift may be appropriate, especially if:
- Your surgeon is aware of any and all medical conditions and any allergies you may have and whether you are a smoker. Also, tell your surgeon about any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
- You are not prone to scarring problems such as keloids.
- You do not smoke.
- You have good facial skin elasticity and strong bone structure.
- You have a good understanding of the limitations of the procedure.
How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery. In addition, you will be given specific instructions about taking or avoiding certain vitamins and medications but here are some general guidelines:
- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed.
- Avoid drinking alcohol a few days before your surgery.
- Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anesthesia.
- Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.
- If your hair is very short, you might want to let it grow out before surgery, so that it's long enough to hide the scars while they heal.
Are there alternatives to this procedure?
Less invasive procedures may be alternatives but they cannot produce the same results as a facelift. To correct deep lines and wrinkles, BOTOX® or collagen injections can be administered. Laser skin resurfacing, dermabrasion and chemical peels can smooth fine lines, while a brow (forehead) lift, eyelid surgery or neck lift target specific areas.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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