Facelift (Rhytidectomy)

As people grow older, the natural aging process, genetic influences, exposure to the sun and other factors cause the skin to wrinkle and sag. In the younger individual, the face is firm and smooth due to fatty tissue directly beneath the skin. The tissue, which fills out the contours of the face, gives it an even, rounded appearance. As an individual ages, the skin begins to sag and fit more loosely. Skin folds become more prominent, particularly around the chin, on the jaw line and on the neck.

In recent years, a remarkable procedure, rhytidectomy or facelift, has been developed to correct these conditions and give people the youthful appearance they desire. This procedure involves the tightening of facial and neck skin and muscles and the removal of excess skin. Often a rhytidectomy is done in conjunction with other facial cosmetic surgeries such as brow and forehead lift, blepharoplasty (eyelid surgery), chin augmentation, liposuction, and rhinoplasty (surgery of the nose). A facelift can be performed any time after signs of aging appear.

Before surgery
Prior to surgery, a medical history of the patient is taken in order to evaluate the general health of the patient. A careful examination is also conducted. The physician and patient discuss together how the face should look and what results can realistically be expected. The goal of the surgery is to produce a pleasing natural appearance. Photographs are taken before and after surgery in order to determine the amount of improvement. The type of anesthesia to be used, the procedure, and possible risks and complications are also discussed by the physician and the patient.

Preoperative instructions may include the elimination of certain drugs containing aspirin for several weeks before surgery in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed to prevent infection. Patients may be instructed to shampoo their hair the night before surgery, and a small amount of hair at the temples or around the ears may be shaved.

The procedure
The surgery can be performed in a physician's office, an outpatient surgical facility or a hospital, depending upon the physician's and patient's preference. It can be done under general anesthesia with the patient asleep or local anesthesia in which the area is numbed and the patient remains awake. Premedication is usually administered to relax the patient.

In the basic procedure, the surgeon works on one side of the face at a time. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. Loose skin is separated from underlying tissue and is pulled up and back and excess skin is removed. Connective tissue and sagging muscles are tightened, and in some cases, fat deposits are removed from beneath the chin and neck. This may necessitate an additional small incision under the chin. Tiny sutures are used to close the incisions.