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Numerous adaptations of face-lift techniques are devised, and each surgical approach has its own risks and benefits, and its own proponents and detractors.

All of the conventionally accepted techniques achieve removal of redundant skin, but it’s the variations in approach that separate many face-lifting procedures. A skin-only face-lift was the earliest form of surgical rhytidectomy. However, this form failed to achieve significant long-term benefits. Cosmetic surgeons of various backgrounds thus sought to achieve a more durable benefit from the surgery, and they are still trying. Therefore, for everyone who is considering undergoing rhytidectomy or having a face-lifting procedure, it would be wise to learn more about it.

What is a face-lifting procedure?

The aging process in the face is mainly an issue of decreasing volumes, principally fat. Nonetheless, at some point it is more expedient, and indeed preferable, to perform a rhytidectomy, or a face-lift procedure. The basic concept of a face-lift is simply to elevate the tissues of the face in order to restore a more pleasant contour. As we age, the face undergoes predictable changes, so in general, as the volumes of fat, muscle, and bone decrease with age, there appears to be an excess of skin and muscle. Then we tend to acquire new less-than-pleasant-looking characteristics. We develop nasal and labial folds, as well as deep, permanent smile lines. We also get double chins and turkey gobbler necks.
I guess you have heard that our enemy is gravity, but some people say we should be thankful for gravity because it gets a bum rap. If gravity caused aging, why don’t astronauts in zero gravity conditions look like teenagers? Gravity just determines how aged faces will appear. Rhytidoplasty, or face-lift operation, helps reduce sagging and wrinkling in the lower face and neck. It does not correct problems around the eyelids or at the corners of the mouth unless a mid-face lift is used, but there still is no ideal nasolabial lift. It does not correct creases at the lips, either.
You may choose this operation for one of two reasons. You could prevent the advancement of aging; relatively young individuals of 40 and younger could appear to stay young. Moreover, it may assist one who already has wrinkles, or whose skin sags, to appear younger and fresher. The amount of improvement depends upon the degree of wrinkling and sagging already present on your face. If minimal, then changes may be subtle but the aging process appears markedly retarded. If the wrinkling and sagging is great, then the results can be very dramatic.

When should a person consider having a face-lift?

When a person should consider having face lifting depends on individual goals and desires. The changes at the age of fifty or sixty tend to be dramatic. However, there has been a trend toward operating on patients at a much younger age then before. While the changes in a forty-year-old might not appear that great, the results of a face-lift can often be quite rewarding in this age.

The risks of face-lift surgery

Unwanted risks of rhytidectomy include possible facial nerve damage. The nerve that provides enervation of the facial muscles is rarely damaged in spite of its close proximity to the surgical dissection. A branch of the greater auricular nerve, a sensory nerve that enervates the ear lobe, is the nerve most often injured. Fortunately, this injury is also rare. Bleeding during the procedure is minimal, but occasionally blood may accumulate under the skin after the operation. Such collections of blood, known as a hematoma, are usually due to the inadvertent ingestion of Aspirin. It could also be due to a product containing Aspirin. Such hematomas require evacuation and can be very difficult to treat once they occur. To prevent this, it is essential that the patient strictly avoids Aspirin intake prior to surgery. Small collections of blood may occur and require simple aspiration or no treatment at all.
Infection is a very rare complication after a face-lift procedure. Hair loss can occur permanently if the follicles are actually injured. However, it is usually only temporary and the hair returns over a period of months.  
Fees for face lifting may vary depending on the extent of the procedure, and prices probably vary more for this one than most others procedures.

Rhytidectomy face-lifts

There are several available techniques and styles of face-lift. Some of these procedures are correcting or improving all areas of the face. On the other hand, some procedures enhance only specific sections. Unfortunately, it seems that different surgeons have different ideas of what these procedures are.  Therefore, it would be wise to include all the types and versions currently known.

    * A standard, conventional or traditional face-lift procedure helps lift sagging skin and its deeper structures. The incision lines are usually along or behind the hairline, and the skin excise and the skin of the face should become tighter and sutured.  It is possible that one surgeon will consider a skin-only facelift as traditional, while another may re-suspend the fat and muscle for the same patient.
    * SMAS, or superficial, or sub-muscular aponeurotic system face-lift is responsible for your facial movements. Without it, you would not be able to smile or appear animated.
    * Platysma Lift or neck lift in conjunction with a SMAS lift is usually the best option. However, that is the most expensive and time-consuming operation.  With the Platysma lift, the platysma muscles tighten, and then sutures as well as the hanging skin and excess fat should be removed to result in a more youthful neck, post-operatively.
    * S-lift procedure was innovated in the late 1960's, although German surgeons further perfected the procedure before its transcontinental migration to the US.  This procedure is common on patients in their late 30's to even their 80's on upwards.
    * Mini-lift is a common procedure; some surgeons consider the lateral lift with incisions directly in front of the ear only. It can help with naso-labial folds problems.  
    * Lateral brow lift is not as common because some like it and some do not.
    * Sub-periosteal face-lift should lift the sub-orbital area as well as the mid-face. The deep plane lift is a relatively new procedure, performed in a deeper plane than in the standard face-lift. This procedure is like a SMAS lift with a little extra oomph for the naso-labial area.

Rhytidectomy face-lift surgeons

After finding several qualified and skilled surgeons, you will probably want to schedule consultations with them. These appointments will give you the opportunity to discuss your needs and have the surgeon state his opinion about you having a face-lift procedure. You should hear what your surgeon thinks you will benefit from. The surgeon or staff should ask for your complete medical history before performing a rhytidectomy face-lift. It is advisable to go over any medical records to refresh your memory prior to your meeting with the surgeon for face-lift consultations. The surgeon should ask, but if he does not, be sure to disclose any allergies that you may have, disorders, and past illnesses. If you are a smoker, make sure you cease smoking long before your procedure. The problem is that smoking greatly decreases vascularity, promoting necrosis of skin, improper healing, and excessive scarring.
Furthermore, be sure to advise your surgeon of the medications you are taking.  This includes, vitamins, herbal supplements, over the counter medications, or anything you might take. You should also discuss the complications and risks of having a face-lift. If he does not discuss with you the risks of your surgery, you should be very wary.

How is rhytidectomy face-lift procedure performed?

A face-lift normally takes from two to five hours to perform. If you are having a Platysma, or neck lift, the surgery will last closer to 5 hours.
Before the surgery begins, the surgeon will mark the incision sites and natural folds while you are upright with a Sharpie type marker. These incisions will follow along the natural lines and creases by the ear, neck, wherever and whatever type of lift you will have. After you receive anesthesia, the surgeon will make the required incisions. He will then proceed to excise either excess, loose skin, or suction or remove excess fat manually, or possibly atrophied muscle tissue. The surgeon will then lift your skin to a desired level. He may insert a drain, and either applies a tissue glue or more than likely sutures and staples. He will then apply a bulky dressing to your face and head to protect your wounds. He will keep the tissue in proper place during recovery and possibly as pressure to help with swelling and prohibit displacement. The recovery nurse will monitor your vital stats after the face-lift. She will monitor you until you are ready to go home. This depends upon the individual, but may take up to two hours or more.
After rhytidectomy, your eyes may feel tight, hot and quite tender as the anesthesia wears off.  If you feel any discomfort, you may want to ask for a pain reliever, which you will bring with you. You may even feel emotional or upset, depending on your body’s reaction to anesthesia.  You may also experience rigors or shivering after the face-lifting.  This may feel uncontrollable and is usually from the medication. More than likely you are going to experience this because of epinephrine used as a Vasoconstrictor. If you do not stay overnight in the hospital, you must have someone drive you home after your procedure. It is dangerous to drive home on your own, and illegal as well; you should have someone present to care for you at least for the first 48 to 72 hours. This is very important should you have a medical emergency or a feverish spike; especially if you are unable to wake up and take medications or drive yourself to the hospital.