Facelift (Rhytidectomy) Fundamentals
Reviewed by Yael Halaas, MD
Let's face it. Injectables such as Dysport or Sculptra can help put the brakes on some of the signs of facial aging, but they are no substitute for traditional facelifts. The effects of these fillers may last anywhere from three months to two years, but a facelift's rejuvenating effects can extend more than 10 years. Injectables target wrinkles and sunken areas of the face, while a facelift actually restores the lower two-thirds of the face and neck. Additionally, a facelift can remove excess skin, tighten muscles and reposition some of the underlying tissues of the face; all of these functions are way outside the realm of injectables.
Obviously there really is no comparison between injectables and facelifts when it comes to their age-defying effects.
That said, it's important to realize that facelift surgery (rhytidectomy or rhytidoplasty) is a major procedure with a significant recovery period and a more involved risk profile than injectables. Weighing the benefits and risks of a facelift is the best way to determine if it is the right facial cosmetic procedure for you.
What Can a Facelift Do for You?
A facelift can correct sagging and tighten loose skin under the chin and jaw. Overall, a facelift can help you look as young as you feel (or younger!).
Are You a Candidate for a Facelift?
If your face is loose and sagging, you may be a candidate for a facelift. Age is not a barrier. Most people undergo facelifts between the ages of 50 to 65, but this is only the average age range. Many people as young as 40 and some older than 80 also opt for facelifts.
It helps to be at your ideal weight when you have your facelift. This can prevent the need for additional surgeries to remove excess skin should you subsequently lose weight. Remember that facelifts cannot forestall the aging process permanently. Nothing can.
The Initial Consultation
A consultation with a facial plastic surgeon can help you determine if you are an appropriate candidate for a facelift. You must be in good general health to undergo a facelift. Any underlying diseases or conditions such as high blood pressure, cardiovascular disease, diabetes or asthma must be tightly controlled to maximize your results and minimize your risk of complications.
If you are an appropriate candidate with realistic expectations, your surgeon should review your entire medical history and take copious notes on your current medication regimen. Be sure to tell your surgeon about any and all medications that you take on a regular basis. Even so-called natural supplements such as fish oils (omega-3 fatty acids), gingko biloba, garlic, ginseng, dong quai and feverfew can cause side effects. Other factors that will be evaluated during this consultation include sun damage to your skin, tobacco and/or alcohol use, stress levels and even your genetics.
It is important that you begin to develop a rapport with your surgeon during this initial consultation. Make sure the doctor is actively listening to your ideas and concerns. You should not feel rushed during the initial consultation.
You also need realistic expectations about what a facelift can do for your face. The consultation is the perfect time to discuss those expectations with your surgeon. It's sometimes helpful to bring a picture of what you have in mind, even one of yourself at a younger age. But keep in mind that ultimately the surgeon will be working with what you have, so listen to his or her suggestions and opinions. It's best to expect improvement, not a miracle.
Your surgeon will develop a plan for your facelift based on your skin's elasticity and your bone structure (a strong jawline and well-defined bone structure are considered pluses). He or she will examine your hairline to plan incision placement. Sometimes other procedures are done with your facelift, such as brow lift or eyelid surgery. These and other options will be discussed during your consultation. For example, certain injectables or facial implants may also help restore volume or correct contour problems in the face. Laser resurfacing, chemical peels, microdermabrasion or dermabrasion may also be recommended to improve certain skin-quality issues.
During your consultation you will also discuss what type of anesthesia will be used for your facelift. Facelifts are performed under general anesthesia or local anesthesia with intravenous or light sleep sedation. Your anesthesia should only be administered by an anesthesiologist, a nurse anesthetist or the surgeon. Ask which it will be in your case.
Be sure to also ask about facelift costs during your consultation. Find out what is covered, what is not covered, and what extras may be required. Get this information in writing. Some surgeons charge a consultation fee, but oftentimes it is credited to the cost of your facelift if you choose to book the surgery with that surgeon. If the overall cost is prohibitive, ask your surgeon about financing plans. Facelifts are usually not covered by medical insurance.
Your Preoperative Appointment
You will have an appointment with the surgeon about a week or two before your facelift surgery. This is another opportunity to ask any lingering questions about facelift recovery, facelift complications or facelift cost.
You and your surgeon will go over your preoperative and postoperative instructions. You may be given prescriptions for antibiotics and pain relievers to fill in advance of your surgery.
You should also be given a preoperative information packet that describes everything you should do and know before your facelift. The packet should include a list of all the medications to avoid before your surgery. Generally, this includes anything containing aspirin or ibuprofen, both of which increase bleeding risk.
All necessary blood work should be completed at least a week in advance of your facelift. If you are older than 40, your surgeon may require a complete physical exam.
If you smoke, quit as soon as possible. Smoking interferes with circulation and healing. It also causes wrinkles and premature aging, both counterproductive to your facelift.
Your Facelift: What to Expect
There are many variations in how a facelift is performed, and different surgeons have different styles and techniques. The types of facelifts vary in several important factors: type of incision, number of tissue layers treated, the area of the face that is targeted and the degree of invasiveness. For more information, read our article on facelift types.
A facelift is usually performed as an outpatient procedure, but overnight stays are a possibility depending on your specific circumstances. The surgery can be performed in a hospital, a freestanding surgery center or in a surgical suite at your plastic surgeon's office. It is important to find out where your facelift will be done and to ask if the site is accredited. The actual procedure can take anywhere from two-and-a-half to four hours depending on the extent of your lift and whether or not other procedures such as a brow lift are being performed at the same time.
During your facelift, you will be hooked up to devices that monitor your heart rate, blood oxygen levels and other vital signs. You may be given an oral sedative to help keep you calm and relaxed. An intravenous (IV) line will be started to keep you hydrated and provide a way to administer anesthesia, antibiotics, and other medications if necessary.
In general, a facelift involves incisions in front of and behind the ear. These incisions may extend into the scalp. Once the incisions are made, your skin is separated from the underlying tissue, and the deeper layers are "lifted." Your surgeon may also tighten the muscles and/or perform liposuction to remove excess fat pockets in the neck and jowls. Any excess skin is either removed or repositioned.
After closing, your surgeon will apply a bulky dressing to your face and head to protect your wounds and help minimize swelling. This dressing may span from the top of your head to underneath your chin.
You are then awakened and brought into the recovery room where you will be observed for about two hours. If your facelift was performed as an outpatient procedure, you will need a friend or family member to drive you home.