Rhytidectomy, or face-lift, remains one of the most commonly performed procedures in cosmetic surgery. The popularity of this procedure is due to its well-established ability to eliminate the sagging neckline and prominent jowling, which characterize the aging face. The technique of face lifting is not a new one, although it has gone through several changes over the years. The original face-lift procedures lifted and tightened only the outermost layer of the face. Modern face-lifting procedures incorporate deeper layers of the facial anatomy to provide a more dramatic and longer-lasting result.
Patient Selection and Preparation
Proper patient selection and preparation are paramount to achieving desirable results. Rhytidectomy is the procedure choice for patients with excess skin and fat in the lower 1/3 of the face. This will produce the characteristic neck “waddle” and the facial jowling commonly associated with the aged population. The cosmetic surgeon has the responsibility of choosing the best approach to achieve the desired result and being sure that the patient is emotionally and physically prepared for the procedure. Patients can sometimes have unrealistic expectations when considering cosmetic surgery. A patient’s inherited features, the quality of the facial skin, underlying medical conditions, and social behavior will all have an effect on the ultimate result. It is imperative that a thorough and truthful history is obtained prior to undertaking rhytidectomy. Two weeks of recovery time is usually required, but can be shorter or longer depending on the patient. Smoking can inhibit the skin’s ability to heal and must be eliminated before the procedure is carried out. Some medical conditions are absolute contradictions to rhytidectomy and will be reviewed during your consultation.
The Procedure
Rhytidectomy is one of the longest facial cosmetic procedures, taking anywhere from 2-1/2 to 5 hours. Careful attention to detail during the dissection and at closure is necessary to avoid the unwanted features, which give the face an “operated on” appearance. Most facelifts are performed under a general anesthetic to assist with patient comfort and to allow the surgeon to proceed in a timely fashion. The procedure can also be performed under a “twilight sedation” if a less extensive lifting procedure is planned or the patient’s condition warrants it. The incisions are neatly concealed in the natural creases around the ears and also within the hairline. Once healed, the incisions are designed to be nearly imperceptible. A facelift is often combined with other facial cosmetic procedures to enhance the overall result. Nearly all facelifts are combined with some degree of facial liposculpture to help eliminate unwanted fat.
What to Expect
A great deal of time is spent preparing the patient for the recovery period following a facelift. Because the surgery is a relatively long one, swelling and bruising are common features. The dressings used post-operatively can be quite extensive and drains are often used to help eliminate any collections of blood or fluid. The facelift patient is usually evaluated on a frequent basis by the surgeon, and within the first 24-48 hours the drains are removed and the large dressings are replaced with much smaller ones. Bruising and swelling decrease rapidly and pain is typically minimal. Patients are encouraged to sleep with the head elevated for the first 72 hours. The incisions will be visible early on, but fade significantly within the 2-4 weeks. Dressings designed to provide support for the facial skin are worn continuously for the first week, then only at night for the second week. Resumption of normal activity is typically possible at 2 weeks but is patient-dependent.
Tips to Remember:
- Deciding to have a facelift is a significant commitment and should not be taken lightly. The best results are achieved in those patients who take the time to prepare themselves emotionally and physically for the procedure. A minimum of 2 weeks recovery time must be anticipated. Complications are uncommon, but when they occur can be very troublesome to both the patient and the surgeon. Avoidance of those factors that can delay healing such as smoking, alcohol, excessive sun exposure, and stress are of vital importance.
- Results from rhytidectomy are among the most dramatic cosmetic surgery. Nervous anticipation is normal. Close cooperation between the patient and surgeon is necessary. With the proper attitude and patience, the healing process can be one of excitement for all involved.
- The use of cosmetics post-operatively will be discussed, but can usually be used in 7-10 days.
- Long lasting results are the goal, but can be affected by the quality of the facial skin, underlying medical conditions and social habits.
