Facelift (rhytidectomy) is a surgical procedure which targets several aesthetic deformities of the face and neck. There are a variety of surgical approaches, each of which has advantages and disadvantages. A facelift is not a specific operation, but rather, a type of operation. Facelifts, like many other aesthetic procedures, are offered to patients who are felt to be good candidates. It is required that a patient displays appropriate self-motivation and has reasonable expectations regarding his or her outcome.
A successful facelift should allow an individual to “look younger, rested and refreshed”. The procedure can not make an individual look like someone else. The outcome and longevity of the facelift is quite variable and depends on several factors including the chosen technique, patient age, skin elasticity, sun exposure, weight fluctuations and history of cigarette smoking.
Facelift techniques range from simple skin tightening procedures to those involving dissection and repositioning of deeper soft tissue layers. The recommended facelift technique is based on the patient’s aesthetic concern(s) and goal(s), findings on examination and the advantages and disadvantages of each approach. The choice of technique will influence the time required for the operation, the recommended anesthetic technique, attendant risks, procedural costs and recovery time. Most importantly, the choice of technique will greatly influence the patient’s outcome.
Patients are frequently confused when they are educated regarding facelift terminology. Words and acronyms such as platysma muscle, “deep-plane” and SMAS can intimidate laypersons. It is more important to obtain a thorough description of the recommended technique during a consultation and understand the concept of the surgical approach.
The evolution of facelift surgery has been remarkable in the past decade due to a greater understanding of the anatomic changes in the face and neck that occur with time. It is critical to distinguish time-related changes of the skin envelope from changes in deeper soft tissue structures such as muscles and fat pads. Isolated skin problems are best solved by skin resurfacing procedures and not facelift surgery. Facelift surgery is most appropriate when the deeper soft tissue elements require repositioning. This results in a balanced, natural appearance and avoids a conspicuous pulled look
Composite Rhytidectomy is an approach which allows repositioning of deep soft-tissue elements which are not separated from the skin envelope of the face. During this facelift procedure, the skin and underlying soft-tissue structures are elevated and repositioned together thereby preserving their intimate relationship with each other. The goal is a natural appearance which displays facial harmony and balance. Composite Rhytidectomy requires dissection in a deep plane and must be done methodically and carefully. This operation is more technically demanding than a simple skin-tightening procedure. Surgery typically lasts 4 to 6 hours, depending on the need for eyelid surgery (blepharoplasty) and/or browlift which are frequently performed concomitantly.
Contouring of the neck and area beneath the chin is always done during facelift surgery. This often requires conservative removal of fat and tightening of the platysma muscle which can form one or more bands in the neck. Browlift, upper lid blepharoplasty and lower lid blepharoplasty are not routinely performed with all facelifts. Many patients wish only to improve the appearance of the lower face and neck and will not require these additional procedures.
Be wary of “limited facelifts” and operations which are advertised as “non-invasive”. Most board-certified plastic surgeons believe that “mini-facelifts yield “mini-results”. The individual seeking rejuvenation of the face and neck should define his/her concerns and priorities during the office consultation.
A thorough consultation is essential for an individual considering facelift surgery. The following topics are typically covered during the office consultation:
- Medical and Surgical History
- History of Cigarette Smoking and Sun Exposure
- History of Skin Care of the Face and Neck
- Occupation and Job Requirements
- Participation in Sports and Hobbies
- Patient Motivation and Expectations
- Examination of the Face and Neck
- Recommendations regarding surgical technique
- Discussion of alternatives (if applicable), and/or adjunctive procedures
- Discussion regarding anticipated recovery and limitation of post-operative activities
- Recommendations regarding anesthesia care
- Follow-up Care in the Office
- Financial Requirements/Considerations
- Scheduling Surgery and Pre-Operative visits
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