Face lift (rhytidectomy): The big gun of facial rejuvenation

As we age, our faces sag, change the contour, and become covered with wrinkles, as the skin and underlying tissues become loose and flabby. The face may also become longer and the jowls more pronounced. These changes are often perceived as signs of advanced age and declining vitality. Face lifts can help to eliminate these effects of aging, giving a person’s face a smoother, younger and bouncier look. This is achieved by repositioning or tightening the skin and muscle tissue. Face lifts cannot eliminate all the signs of aging, as they mostly affect the lower and middle parts of the face, as well as, in some versions, chin and neck. However, a face lift generally does not eliminate the wrinkles in the corners of the mouth, crow’s feet near the eye, or wrinkles on the forehead. Nor does it affect skin texture. Therefore, for the most dramatic results, a face lift may need to be combined with other procedures, such as eyelid surgery (blepharoplasty), laser resurfacing, brow lift, dermal fillers, and so forth.

Many signs of premature aging as well as congenital and accident-caused flaws can be corrected with facial plastic surgery. Face lifts of different kinds are effective in improving looks for people from their mid-30s to their 80s, although the risks associated with invasive surgery tend to increase at a more advanced age.

Face lift: the procedure

A surgeon would meet with the person considering a face lift prior to the surgery to discuss the options, risks, and alternatives to face lift (rhytidectomy), and also set realistic goals for the procedure.

Face lift usually requires general anesthesia (or a combination of local and mild general "twilight" anesthesia) and generally takes between two and four hours to perform. It can be done as an outpatient procedure or involve a short hospital stay.

The surgeon would make an incision near the temple hair (a little above and just in front of the ear), and continue the incision around the ear, back into the hairline. Similar incisions are made on the other side. The incisions follow the hairline and natural creases to make them less visible after the surgery. The skin is then lifted outward from the underlying tissue (this procedure is called "undermining"), and the surgeon moves to the cheeks, neck and the area under the chin, repositioning the muscle, removing the excess fat and skin, and tightening some muscle strands reaching into the shoulder, for more lasting results. The surgeon would then pull the skin into place and close the incisions with sutures or staples.

After the surgery

The patient would receive a pressure bandage to lower the risk of hematoma (a pool of blood forming under the skin). Staying in a recovery room for several hours may be a good idea to make sure there is no bleeding, after which the patient may go home. It is usually necessary to make arrangements for someone to drive the patient home and stay with the patient for the first 24 - 72 hours. Swelling and bruising is likely (and can be reduced with ice packs), so hiring a registered nurse could be a good way to spare one’s family and friends from a potentially traumatic experience. Individuals should lie down as much as possible at least during the first 24 hours, and should take antibiotics for up to a week following rhytidectomy. Most sutures would be taken out within a week. Strenuous activity (such as bending or lifting) may trigger bleeding and should be avoided in the first 1-2 weeks. Some bruising is normal and may continue for two weeks or more after the surgery, while swelling may take a few months to resolve. The incision scars should fade after about six months; the full effects of the face lift should also become clear by that time.

Some individuals may want to spend the first two weeks after the surgery in private, until most of the bruising and swelling goes away, and it may be a good idea not to schedule participation in high-profile social functions until at least a month after the surgery.

The results of face lift surgery may be dramatic or somewhat subtle depending on the individual’s age, skin type and the type ("depth") of rhytidectomy performed.

Types and costs of face lifts

There are several types of face lift (rhytidectomy) that vary by technique, invasiveness, and cost. Some of them are suitable for younger people or people of weaker health, while others are appropriate for older individuals with more pronounced signs of aging. Common types of face lift surgery include SMAS, deep plane lift, mid-face lift, endoscopic face lift, and thread lift.

Superficial musculoaponeurotic system lift (SMAS) is described in the Procedure section above, works best in individuals over 45 whose faces begin to sag, jowls become visible, and neck muscles grow lax. This is a longer procedure with longer-lasting results and can cost between $10,000 and $15,000.

The deep plane lift involves even deeper tissue layers than SMAS and works for older people with severe sagging and laxity, which affects the mid-face area and creates longest-lasting effects (up to 15 years) and costing from $12,000 to $15,000.

Mid-face lift can be stand-alone surgery or part of SMAS or deep plane lift to improve the lines in the mouth and nose area and to lift cheeks. This works best for middle-aged people in their 40s and 50s with some laxity, sagging cheeks and skin folds in the mid-face area. Mid-face lift surgery achieves moderate results with minimal risk and costs between $6,000 and $10,000.

Endoscopic face lift works best for younger people without too much excess skin and no neck sagging. The surgeon usually makes four small incisions to insert the instruments and scopes. This method is less invasive than conventional SMAS, causes less bleeding and lowers the risk of nerve damage. Also, it requires a relatively short recovery period. Endoscopic face lifts cost between $6,000 and $10,000.

Thread lift produces slight short-term improvements with minimal invasiveness and lowest cost ($1,500 - $4,500). It is performed by inserting a thread with sutured barbs to rearrange skin layers and tighten the skin, thus reducing facial sag. The suture barbs do not dissolve, but rather remain in place support the new face contours. Thread lifts work best in younger people with firmer skin. One of the main risks with thread lifts is barb migration which may cause unpredictable changes in facial features. However, it requires shorter recovery than other types of face lifts.

The cost of the more invasive types face lift includes about $1,200 in anesthesiologist fee and up to $2,000 - $2,500 in facility fees. The surgeon’s fee accounts for most of the remaining cost.

The cost of a face lift depends on the geographic location (it is more expensive in some states than in others), skin type (people with weathered or sun-brunt skin may require longer, and consequently more expensive surgery) and other unique characteristics of each case. Face lift is an elective procedure and is generally not covered by most health insurance plans unless it is done as part of reconstructive surgery after an accident. However, financing plans may be available making the procedure affordable to a broader demographic.

Risks

Face lifts are not for everyone. SMAS and deep plane rhytidectomy especially are invasive surgical procedures and are usually attempted on generally healthy individuals. Fairly common (but still quite rare, with likelihoods of less than 1%) serious risks include nerve damage (especially with deep-plane face lifts) and infection. Infections may require drainage and are treated with antibiotics. In fact, a physician would often prescribe antibiotics preemptively to avoid infection in the first place.

A few key precautions may help reduce most risks. People should stop taking any medication that affects blood clotting approximately a week before the surgery and refrain from it for at least a week after it is completed. Research has shown that smoking interferes with healing and severely (by up to 1,500%) increases the risks of complications (such as skin necrosis). Therefore, most surgeons advise patients to stop smoking at least two weeks prior to rhytidectomy and abstain for another two weeks after the surgery to allow the healing to take place. Conservative surgeons even recommend patients to abstain from smoking for a month prior to and after the surgery.

Apart from smoking, diabetes and poor blood circulation tend to increase many of the risks associated with face lift surgery.

Alternatives to face lift

For those who cannot undergo face lifts for health, personal or financial reasons, other options may produce similar albeit probably less dramatic results. These include radiofrequency lift, laser resurfacing, dermal fillers and others.

Conclusion

Face lift (rhytidectomy) is a powerful tool for reducing the signs of facial aging, often producing substantial and long-lasting results. You may want to consider or discuss rhytidectomy with a plastic surgeon if:

• your skin begins to sag in the face and neck
• your skin retains elasticity
• your health is reasonably good
• your bone structure is strong

It is important to have realistic expectations - the effects of face lift surgery may be dramatic or they may be more subtle. Individuals considering the procedure should discuss their options and possible results with an experienced board-certified plastic surgeon who should be able to answer their questions, address concerns and provide additional information on this procedure, including before and after photographs and patient testimonials.

The deeper and/or more radical versions of face lift operation can produce long-lasting results (up to 10 years or even more). However, even those results will not be permanent. On the bright side, face lift may be repeated after the effects of initial surgery fade.