Face Lift

When most people think of cosmetic surgery to make you look younger, the first surgery that pops into their minds is a face lift. Many peoplehave face lift surgery (also known as rhytidectomy or rhytidoplasty) to enhance their features and restore a young look. In the past, most people waited until their mid 40s or 50s to have a face lift, but now there is a trend for people as young as 30 to have less involved facelifts.

face lift surgery

The idea is that a little work done early can forestall or delay a larger procedure. There are minor procedures such as cheek pad lifts (a midface lift) and less invasive temporal lifts (lateral brow lifts) which can return a young-looking appearance .

A face lift can improve your appearance and give you a look that can be dramatically younger or just make you look refreshed and well rested. You must tell your surgeon the amount of change you want you have, but also listen to what he or she thinks is realistically possible.

You have to have realistic expectations for a face lift. You cannot go from looking like you are 60 to looking like you are 18. It can give you back a more youthful appearance and refresh your otherwise tired-looking face. You also have to understand that having a face lift won't change who you are, but it If you believe that you look older than you feel, a face lift may match your outside to your inside.

What Is a Face Lift?

A face lift is also called rhytidoplasty or rhytidectomy, from rhytides, the Greek word for wrinkles. A face lift is surgery designed to reduce sagging, wrinkling, and jowls in the lower face and neck. It cannot correct wrinkling around the eyelids (crow’s feet), at the corners of the mouth (unless a mid-face lift is also performed), or the vertical wrinkles around the lips. A face lift can prevent the advancement of aging and help relatively young individuals (40 and younger) appear to stay young, or it can help someone who is already wrinkled or whose skin sags look younger and fresher.

The amount of improvement from a face lift depends on how much wrinkling and sagging you already have. If wrinkling, sagging, and jowls are minimal, then the changes may be subtle, but the surgery will appear to slow down the aging process. If the wrinkling and sagging is great, then the results can be very dramatic.

Are You a Candidate for a Face Lift?

To be a candidate for any cosmetic surgery, you have to be in good health. If you have any underlying diseases or conditions such as high blood pressure, diabetes, or asthma, it must be under control. You also have to have realistic expectations of what a face lift can do for you. It can make your look a bit younger and more refreshed, it will not make you any younger nor will it change any other aspect of your lift. You also have to be able to communicate your goals to your surgeon so that he or she understand what you want done and can determine if that can be realistically achieved.

You must be mentally and emotionally stable to undergo a face lift. You need patience and stability to deal with the healing period, when your face will be sore, swollen and bruise. It is not uncommon to become depressed after any surgery. If you are already prone to depression, this low period can develop into a more serious issue. Please consider this before committing to a procedure.

Also, if you are considering losing a considerable amount of weight or in the process of losing it, you should wait until you reach your goal weight. If you have the face lift too early, you may need additional surgery to remove excess skin. However, it is not unheard of for people to have several facelifts in their life.

Types of Face Lifts

There are several available face lift techniques and related lifts. Some procedures correct or improve most areas of the face and some enhance and improved specific sections. Each of these techniques has variations and and many can be combined.

Standard, Conventional or Traditional Lift: This is a procedure designed to lift sagging skin and, sometimes, the muscles under the skin. The incision lines are usually placed along or behind the hairline. The skin is loosened and pulled upward, and excess skin is excised. The skin of the face is lifted upward into a new position, and sutured into place. Some surgeons also excise some facial fat and rearrange facial muscles and still call it a traditional lift.
SMAS (Superficial Muscular Aponeurotic System) Lift: The SMAS is the connected system of muscles, connective tissue, and other tissues responsible for you being able to smile, frown, or make other facial expressions. This type of face lift depends on moving and rearranging the components of the SMAS to lift the facial structures into a more youthful position. The SMAS area is lifted up and out—diagonally would be the best way to explain it.
Platysma Lift (neck lift, platysmaplasty): For many people, their main cosmetic problem is loose skin under the neck and hanging jowls. The sheet of muscles that lie just under the skin of the neck, the platysma, may have loosened and started to sag along with the skin. With the platysma lift, the platysma is tightened and sutured as an excess skin and fat are removed to result in a more youthful neck.
S-Lift: The S here stands for the S-shaped incision that is made in front of each of your ears. The skin and other layers of your face are loosened and pulled to the side. This lift works on the lower third of the face, and the jaw line, jowls and neck can also be smoothed. The incision scars are hidden in the natural folks in front of the ear.
Minilift: A minilift is a phrase used to describe a midface lift, a cheek pad lift, and some other types of lifts when done to change the face minimally. It also uses incisions directly in front of the ear. It can somewhat correct the nasolabial folds, the creases that run from the side of the nose to the corners of the mouth.
Minilift (with suture suspension): In this minilift surgery, sutures are anchored into or suspended from the underlying muscle using either surgical barbs that hold the suture in place or a small screw in the skull.
SOOF (suborbicularis Oculi Fat) Lift: This procedure is designed to reposition the suborbiularis oculi fat, a pad of fat under the eye, to help correct a hollow or skeletal looking under eye area. Some surgeons include a cheek pad lift also.
Subperiosteal Facelift: This technique was designed to lift skin and tissues at a deep level, just over the bones of the face. It can provide lifting and rejuvenation in the suborbital area, the area under the eyes, as well as the midface.
The Deep Plane Lift: This facelift is also performed in a deeper plane than in the standard face lift. It is like a SMAS lift, but can supply extra correction to nasolabial lines that run from the side of the nose to the corners of the mouth. Because this procedure is performed at a deeper level, there is a greater risk of facial weakness due to nerve injury after the procedure.
Temporal Lift (Lateral Lift, Lateral Brow Lift): This lift moves the facial tissues diagonally outward and upward toward the upper corners of the face. It can produce an exotic look to the outer arch of the brow or an exotic, cat-like look. This is good if it is what you want, but if you don’t want to look exotic or cat-like, you should consider avoiding this kind of life. It can relieve folds and small wrinkles in the forehead, the area between the brows, and crow's feet. A temporal lift also lifts the cheek skin and can restore a more chiseled look to the cheekbones. Because it adds tension to the skin that is lifted, you may run the risk of stretched or widened scars. There are variations on this lift that include internal suture material, suspension, and underlying muscle tightening.
Tissue Glue Face Lift: This technique actually involves a different type of incision closure, a fibrin tissue glue that is applied the full length of the incision. Closing the incisions with tissue glue is thought to have a faster recovery time and less bruising and reduced scarring. Because the tension is across the incision as a whole, rather than just where there are sutures. There is also no need to have sutures removed as the tissue glue dissolves by the time it is no longer needed.
Midface Lift: A midface lift is a minimal face lift that is a good option for younger patients who don’t need a full face lift yet. It provides a refreshed look regarding sagginess around the under eye, nasolabial area, and upper mouth and outer upper lip area. A midface lift can be performed with an open technique or endoscopically, using fiber optic tools and techniques. An open technique midface lift does not affect the brows so you might want a brow lift. With an endoscopic midface lift, the outer brow is rejuvenated as well.
- The open technique is performed through an incision under the lower lash line and sometimes with an additional small incision within the nasolabial fold. This is a great option for those needed more of a vertical lift rather than a horizontal or diagonal lift. There is usually a subtle result and rejuvenation rather than a major change of appearance.
- The endoscopic technique requires two incisions in the scalp above the temples, which is why it can improve the outer eye, temple, and brow. It is like a temporal lift in conjunction with a mid-face lift. However, it is more invasive and requires a few days more recovery and more bruising and swelling. But it is more effective for a face that needs more lifting vertically and diagonally. There is a risk of a slightly unnatural windswept look if is not performed correctly. Then again, you might want that.

What to Expect at Your Consultation

Ask around and collect the names of several surgeons who specialize in face lifts. Check on their backgrounds and credentials, then make a consultation appointment with one or a few. You will meet with these surgeons and discuss your goals and how you want your face to look. Your surgeon will explain the technique and incision placements or methods and also make sure that your goals are realistically possible.

You and the surgeon will go over your medical history and family history. Bring with you a complete list of any prescription drugs you take, and any vitamin or mineral supplements or herbal products. Tell the surgeon everything about what you take and your medical history. Do not hold back anything because you think it is embarrassing.

You will also discuss what type anesthesia will be used for your face lift. More extensive face lifts on the deeper planes of the face are performed under general intravenous sedation, although light sleep sedation is a possibility. Either way, discuss this thoroughly, because many people are not aware of the risks of anesthesia. Also find out who will be administering anesthesia, since it can be an anesthesiologist, a nurse-anesthetist, or the surgeon. We have a whole page of information about anesthesia that you should read so that you can make a fully informed choice.

A face lift is usually done on an out-patient basis and can be performed in a hospital, a freestanding surgery center, or in a surgical suite in your plastic surgeon’s office. Find out where your face lift will be done and ask if the site is accredited.

During the consultation, you will also discuss fees. Find out what is covered, what is not covered, and what extras may be required, such as blood tests. Get this information in writing. You can choose to book or reserve a surgery date at our consultation or you can call in later to do so. You will usually give a deposit to hold that date. This deposit is refundable if you cancel well in advance of the surgery. If you cancel too close to the surgery, it is not refundable.

We also have a page of information on Consultations.

Your Preoperative Appointment

You will have an appointment with the surgeon a week or two ahead of your surgery. This is another chance to ask more questions and make sure your surgeon is aware of what you want from your face lift, just as your surgeon will make certain you know what it realistically possible. If you remember something when you get home or the next day or even the day of surgery, don't be afraid to ask.

You and your surgeon will go over your preoperative instructions and discuss the recovery period and what to expect. You may be given prescriptions for antibiotics and pain relievers.

Preparing for Your Surgery

You may be given a preoperative information packet that describes everything you should do and know before your surgery date. The packet should include a list of all the medications to avoid for a week or two before your surgery. Generally, this includes anything containing aspirin or ibuprofen. However, make sure your surgeon has a complete list of what medications you take. We have a partial list of Medication and Supplements that should be avoided before surgery. However, you must ask your surgeon specific instructions about your prescription medications and not stop taking them on your own.

You will be asked to have blood tests done before your surgery to check on your health. This must be done at least a week in advance so that results are available. You may also be asked to have a complete physical if you are over age 40 and have not had one in some time. These will be out-opf-pocket expenses and will not be included in the fee for your surgery.

If you smoke, stop. It is really important to quit smoking as far in advance of your surgery as possible. Smoking seriously interferes with circulation and healing. It also contributes greatly to aging of the skin and face. Please consider these risks.

Your surgery will be here before you know it so visit our Preparing for Surgery page. This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day.

How a Face Lift Is Performed

There are many variations in how a face lift is performed, and different surgeons have different preferences. This is just a general outline of how a typical one is done, which assumes that there is such a thing as a typical face lift. A face lift normally takes between 3 and 6 hours to perform, depending on how extensive your lift will be. If you are having a platysmaplasty (neck lift) and a brow lift as well, the surgery may last closer to 6 hours.

You will be hooked up to devices that monitor your heart rate, blood oxygen levels, and other vital signs and preparations will be made for anesthesia. You may be given an oral sedative to help keep you calm and relaxed. An intravenous (IV) line will be started. This will help keep you hydrated and provide a means of administering anesthesia, antibiotics, and other medications.

Having an IV inserted pinches a bit. Usually, it is placed in the crook of the elbow, but it all depends on your veins. A bag of saline (sterile salt water) or other fluids will be hooked up to the IV line. Medications will usually be given with a drip system with this fluid. If you are getting IV sedatives, they will be administered through the IV. You will feel the effects of the anesthesia quite soon after they are started.

In a face lift, the incisions will follow along the natural lines and creases by the ear, the neck, or in the hairline depending on what technique is being used. Your surgeon should make every attempt to create inconspicuous scars.

Your surgeon will then dissect your skin and/or the muscles of your face from the underlying structures, depending upon the type of lift and desired results. He or she will then proceed to remove excess skin and (if any) excess fat, and possibly loosened or stretched out muscle. If permanent suspensory sutures are being used, they will be inserted, attached to screws or barbs that will be permanent. The surgeon will then lift your skin to the desired position, and apply sutures and staples and or possibly a tissue glue.

Your surgeon will then apply a bulky dressing to your face and head to protect your wounds, keep everything in place during recovery, and sometimes to apply pressure to help with swelling and prohibit displacement. This dressing may go from around the top of your head to underneath your chin.

You are then awakened and brought into the recovery room where they will kep an eye on you until you are released. Usually, you will be kept under observation for about 2 hours. Your face may feel tight and quite tender as you awaken. You may even feel emotional or upset or very cold, which are normal reactions to anesthesia. If you are cold, ask for a warm blanket. You may also feel nauseated. If you think you will throw up, alert the staff. They can give you some medication and one of those kidney-shaped plastic bowls.

You will have to be driven home by a responsible adult. You will not be able to drive yourself home because you will be groggy and bandaged. If you do not have someone to drive you home, you may not be released.

The Road to Recovery

You may get sick on the ride home from the surgical center or hospital so have a bucket or can with a lid ready. You might also bring some water and some mild crackers to help with the nausea. Bring pillows and a blanket if you want to make the ride more comfortable, especially if the ride is a long one.

If you hurt take your pain relievers. There is no reason to suffer. Studies have shown that patients with increased pain heal slower than patients who are not in pain. If you wait for the pain to be severe before you take your pain pill, you often end up having to take more of it than if you nipped the pain in the bud. However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately.

You may be groggy from the anesthetic and medications and may not remember much of your first day or two after your face lift. Take it easy.

You must sleep with your head elevated for about 14 days. Sleep on two pillows to keep your head elevated or use a wedge-shaped foam pillow that you can get from a pharmacy or surgical supply store. You can also sleep in a recliner if you have one.

You must keep your head still as much as possible. Do not turn your head from side to side. Move your whole body, if you must move.

Your face will look even more swollen in the first three days than it did on the first. You won't usually be extremely swollen until late that night or the next day and then the third is by far usually the worst. But, as the days go on the swelling will dissipate. There may be a lot of bruising, but this will go away, as well. So make a mental note of this or you may be shocked into a depression. Bruising and swelling are normal in most surgeries. If it helps, avoid looking at yourself in the mirror for the first 3 or 4 days.

Although any discomfort should be relieved by your prescribed pain medication, if you have excessive pain, redness, pus, an elevated temperature, or other symptoms that do not appear normal, contact your surgeon immediately. Take your temperature regularly. An elevated temperature could mean an infection. Take your antibiotics on time.

There are some face lifts and other facial procedures (such as cheek or chin implants) that involve incisions in the mouth. If you have had incisions in your mouth, your diet may be restricted. While your oral incisions are healing, wash all fresh fruits and vegetables and avoid raw fish (sushi), very rare meat, or anything that may contain high amounts of bacteria. You may be instructed to rinse your mouth out with an antiseptic mouthwash several times a day. Do not pick or tongue your incisions or sutures!

Usually, your first postoperative visit is the day after your surgery. The surgeon may change your bandages or may wait until the end of the week, depending on the amount of seepage or the extent of work. Your sutures won't be removed until 5 to 7 days after surgery and any staples in your scalp won’t be removed until around day 10. Your scalp takes longer to heal.

Your skin will be numb. This is quite normal because some of your facial nerves will have been disrupted. Give them time to recuperate. Take it easy and try not to do too much, too soon. You should be up and about in the first few days but don't feel guilty if you don't. Listen to your body.

However, you should not just stay in bed for the first few days. Get up and gently walk around three or four times a day. This helps your circulation and helps prevent blood clots in your legs.

Even though you may feel better, take it easy for the first 3 weeks. Do not bend over or lift heavy objects. Do not do anything to raise your blood pressure for at least 3 weeks. Elevated blood pressure could cause internal bleeding at your treatment area. Do not participate in contact sports for at least 6 to 8 weeks; your doctor may specify a length of time.

NO steam rooms or devices, saunas, or steam face masks or products of any kind that promote flushing of the skin. No supplements containing niacin, niacinamide, or niacinamate, which can also cause flushing and make your face red.

Even a relatively minimal face lift surgery is very involved and requires very strict postoperative care. Again, take it easy and do as your surgeon tells you.

Continue to avoid alcohol and products containing aspirin or ibuprofen for a few weeks or until your surgeon tells you. If you quit smoking before the procedure you really should not start back up. Smoking greatly impairs your circulation and promotes tissue death, improper healing, and excessive scarring. Quit smoking, period.

You may notice a change in your smile, odd sensations of tightness, tingling, sporadic sharp pains, or pulling, burning, and cold sensations. These usually subside within the first few weeks. Your swelling will subside, revealing a more defined, youthful version of yourself. But this will take some time, so please prepare yourself emotionally. Some patients experience a lull or down period where they become depressed or feel unattractive. This is very normal. Please print out our Emotional Preparation Sheet so that you will be able to remind yourself that you will get through your low period.

Risks and Complications of Rhytidectomy

There are quite a few risks with a face lift, or rhytidectomy. You could have an allergic reaction to the anesthetic. Although extremely rare, you may bleed excessively and require another surgery to control and drain the collected blood.

You could develop a hematoma (a pocket of clotted or liquid blood) or a seroma (a collection of the watery portion of the blood. These might heal by themselves or might have to be drained.

You may lose sensitivity on your face, although this is usually temporary. However, permanent loss of sensation on the face can happen.

You may also lose the ability to more a part of your face due to nerve injury. Of the nerves of the face, the nerve supplying the forehead, scalp, and adjoining parts is most likely to be injured. The nerve that supplies sensory fibers to the lower jaw and parts of the mouth can be injured during platysmaplasty (neck lift). Nerve injury is rare but can occur.

There is also a risk of excessive scarring or scar formation under the skin.

If too much skin is removed or if inadequate incisions are placed, there may be too much tension on the incisions and facial skin. Excessive tension can widen scars or cause hypertrophic scarring is possible, especially in individuals who are prone to that. If this happens these scars can be treated with repeat injections of corticosteroid drugs every month. These injections help calm inflamed tissue and break up the excess scarring.

You also could have a piece of skin or other tissue die because of poor circulation or an interrupted blood supply. Topical and oral antibiotics will help but the dead tissue must be removed.

If you have a traditional face lift with an incision behind your hair line, you can have hair loss along the incision lines, of the head in general, or loss of facial hair, such as eyelashes or eyebrows. Usually, the hair will grow back, but the loss may be permanent.