Facelift (Rhytidectomy)

What is a facelift?

A facelift is a type of plastic surgery to change how your face looks. Over time, lifestyle habits such as smoking, sunbathing, outdoor activities, and stress can change the appearance of the face. As people age:

• Deep creases form between the nose and mouth.
• The jaw line grows slack and sags.
• Folds and fat deposits appear around the neck.

When a facelift is done, face and neck skin are removed and the tissues under the skin are tightened. The technical term for this procedure is rhytidectomy.

When is it used?

You are most likely to have good results from a facelift if your bone structure is strong and well-defined and your skin has some elasticity. A facelift can be done by itself, or along with other procedures such as eyelid surgery or nose reshaping. Health insurance usually does not pay for elective cosmetic surgery such as a facelift.

How do I prepare for a facelift?

• Tell your healthcare provider about your health and any problems that you have. Some health problems, such as high blood pressure, blood clotting problems, or edema, could cause problems during or after surgery. Also tell your provider if you tend to form scars easily.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery. Many surgeons will not perform facelifts on current smokers.
• If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you should stop taking it before your surgery.
• Be sure to tell your healthcare provider what medicines you are taking, including nonprescription drugs, such as aspirin, and herbal remedies.
• 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.
• Arrange for someone to drive you home after your surgery.
• Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water. If you take daily medicines, ask your provider if or when you should take them.

What happens during the procedure?

A facelift may be performed in an outpatient surgery center or in a hospital. You will probably be given local anesthesia, along with a sedative to make you drowsy. You will be awake but relaxed, and your face will not feel pain. You might have general anesthesia instead, which means that you will sleep through the surgery.

Facelift surgery typically lasts 2 to 5 hours. The surgeon makes a cut from the temple, around the earlobe, to the back of the neck. The cuts are made in the natural creases and lines of the skin to hide scars. After it is separated from muscle and fat, the skin is pulled upwards. Excess skin is then cut away. Muscles are tightened and excess fat is removed. The surgeon will use stitches to close cuts on the face. Metal clips may be used on the scalp.

You may have a small, thin tube temporarily placed under the skin behind your ear to drain any blood that might collect there. Your head may also be wrapped loosely in bandages to decrease bruising and swelling.

What happens after the procedure?

Your face will be swollen for awhile. Your facial movements may be slightly stiff and you may feel self-conscious about your scars. You may have some bruising and swelling for 2 or 3 weeks, and you may tire easily. To keep the swelling down, keep your head elevated and as still as possible for a couple of days after surgery.

Bandages are usually removed after 1 to 5 days. Most stitches will be removed after 4 to 7 days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline may be left in a few days longer.

Pain is usually minor and can be controlled with medicine. Avoid strenuous activity, including sex and heavy housework, for at least 2 weeks. Avoid steam baths and saunas for several months. Do not drink alcohol if you are taking pain medicine.

During the healing process, the skin on your face or neck may feel numb. This usually goes away in a few weeks or months.

What are the risks with this procedure?

Complications that can occur include:

• hematoma (a collection of blood under the skin that must be removed by the surgeon)
• injury to the nerves that control facial muscles, which may be temporary or permanent
• infection
• reactions to the anesthesia.

Having a facelift does not stop the aging process. Your face will continue to age. Results depend on your age, skin elasticity, and your future exposure to sun and cigarette smoke.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever over 100°F (37.8°C) or higher.
• You have a lot of swelling, redness, or pain near the incisions.
• You have drainage from the incisions.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.

To find a plastic surgeon who performs this procedure, call one of the national organizations of board-certified plastic surgeons.