Facelift – Rhytidectomy
The characteristics and appearance of our faces change as we grow older and these changes usually start as we enter our 30’s. As we age the skin begins to loosen on the face and neck. The wrinkles known as Crow’s feet on the lateral or outside of our eyes begin to appear. Our jawlines may soften into jowls and vertical folds appear under our chin. The aging process and the resultant changes in our facial appearances are influenced by a number of important factors including: personal habits, genetics, the pull of gravity, sun exposure and smoking.
It is advisable that you first discuss this procedure with your General Practitioner (GP), who may then refer you to the Consultant Plastic Surgeon of your choice. Sharing your expectations with your GP and surgeon is the best way to increase the possibility of achieving your desired outcomes.
A facelift involves the tightening of facial and neck skin tissues, re-orientation of muscles, and repositioning of fat, with re-draping of the skin. A facelift is sometimes performed in conjunction with other facial aesthetic procedures, such as a brow lift, forehead lift, or eyelid surgery. Also, a facelift is a basis for other non-surgical treatments such as dermal fillers. A facelift is a delicate procedure that tries to recreate the beauty and harmony of young facial contours.
Through discreet facelift incisions, your Consultant Plastic Surgeon is able to free the skin from the underlying tissues to the extent necessary for the particular surgical technique selected. After the skin has been pulled up and back, the excess is removed. In many instances, the deeper tissues may also need to be repositioned in order to restore a more youthful contour to your face. Occasionally, a small incision beneath the chin permits the removal of fatty tissue in that area and smoothing of the cord-like structures of the underlying muscle in the neck.
A facelift cannot stop aging, nor can it turn back the clock. What it can do is help your face look its best and give you a look of health and a more youthful appearance. One benefit is that many patients experience increased self-confidence. A facelift is usually an option for people in their 40s, 50s, or 60s, but the procedure may also be performed successfully on people in their 70s and 80s. Plastic surgery of the face makes it possible to correct many facial flaws and signs of premature aging that can undermine self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself.
Understanding the limitations of a facelift is crucial and psychological stability is vital. There is no ideal in a facelift. Rather, the goal is to improve the overall facial appearance. Skin type and thickness, degree of skin elasticity, individual healing, basic bone structure, ethnic background, as well as a realistic attitude are factors that should be discussed prior to surgery. If you’re considering a facelift, you will need to discuss your full medical history with a Consultant Plastic Surgeon.
Successful plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery is performed. Your surgeon can answer specific questions about your specific needs.
Your choice of a fully qualified plastic surgeon is of paramount importance. It is advisable that you first discuss this procedure with your G.P., who may then refer you to the Consultant Plastic Surgeon of your choice. Sharing your expectations with your G.P. and surgeon is the best way to help ensure you get the results you want. So, a comfortable, encouraging doctor-patient-surgeon relationship is important.
You will need to find a Consultant Plastic Surgeon with the relevant skills and experience. Your Consultant Plastic Surgeon should be on the Specialist Register of Plastic Surgeons of the Irish Medical Council. He or she should also be resident in Ireland and be easily contactable after your operation for comprehensive and continuous care
After the decision to proceed with a facelift is made jointly by you and your surgeon, the surgeon will describe the type of facelift and technique indicated, the type of anaesthesia, the hospital, any additional surgery, the pros and cons to include the benefits and potential complications and possible risks and costs of the procedure.
During the first consultation, your Consultant Plastic Surgeon will evaluate your health and medical history, discussing your hopes and expectations for the procedure. Your surgeon will also examine the structure of your face, skin texture, skin elasticity, soft tissue structure and underlying bone skeletal framework. Specific individual risks will also be explored especially those related to medical situations such as high blood pressure, a tendency to scar, smoking, medications and any deficiency in blood clotting. As well as assessing your general health and facial appearance, your surgeon will assess your mental and emotional attitudes toward the surgery. Because a realistic attitude is crucial to the success of the surgery, the surgical procedure and realistic expectations will be discussed.
If several flaws need correction, more than one procedure may be necessary for the best overall result. Other procedures include surgery on the eyelids, forehead, neck and chin as well as non-surgical treatments such as wrinkle treatments, dermal fillers and laser treatments.
Your surgeon may take photographs before and after your surgery to help in planning the procedure and to allow you to compare the results after surgery. Your surgeon may also wish to advise your G.P. of the planned procedure.
If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed with the operation by signing a Consent Form.
The surgeon begins the incision in the area of the temple hair, just above and in front of the ear, and then continues around the lobe, circling the ear before returning to the point of origin in the scalp. The skin is raised outward before the surgeon repositions and tightens the underlying muscle and connective tissue. Some fat may be removed, as well as excess skin. Following surgery, incisions can be easily concealed by your hair or with makeup. There may also be a small incision hidden underneath your chin.
Other types of facelifts may be used, especially in younger patients with less skin laxity but with sagging soft tissues such as cheek jowls and fat pad descent on the cheeks. Various terms are used for these types of facelifts including “MACS” (Minimal Access Cranial Suspension), “Quicklifts”, S-lifts and “minilifts. With these “minimal access” facelifts, less intrusive incisions may be used, often avoiding incisions behind the ear and lower scalp.
For men, the incision is aligned to accommodate the natural beard lines. In all cases, the incision is placed where it will fall in a natural crease of the skin to help reduce the risk of the scar being noticed. After trimming the excess skin, the surgeon closes the incisions with fine sutures and/or surgical metal clips, which permit surgery without shaving hair from the incision site.
Ideally your facelift surgery should be performed in a major hospital.
Medications are administered for your comfort during the surgical procedure. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
The Consultant Plastic Surgeon shall decide whether to use a general or local anaesthetic: typically the patient will experience very little discomfort. Depending on the extent of the surgery, the process can take from two to four hours. Following the surgery, the surgeon will apply a dressing to protect the entire area where the incisions have been made.
Even though most patients experience very little pain after surgery, the surgeon will still prescribe medication. Some degree of swelling and bruising is unavoidable, and your surgeon may instruct you to use cold compresses to keep swelling to a minimum. If a dressing has been applied, it will be removed within one to two days. The surgeon will also instruct you to keep your head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort. Though there are few risks in facelift surgery and thousands are performed every year, some risk exists in any surgery.
After the facelift is complete, your surgeon will close the incision and apply bandages for a day or two to the site of the surgery. You will need to stay in hospital overnight.
In some cases, a drainage tube may have been inserted during surgery. This will be removed on the first or second day after surgery. All sutures and staples are usually removed between 4 and 14 days following surgery, depending on the site of the sutures and staples. Surgeons generally recommend that patients avoid vigorous activity. Patients should organise support from family and friends, especially with transport home after their discharge from hospital.
For several days after a facelift, it is perfectly normal to experience some pain, discomfort, swelling, and bruising. Your surgeon will prescribe pain medicine to help with these symptoms during your recovery. Usually your surgeon will allow you to wash your hair within a few days of surgery after the dressings are removed. Most bruising will disappear within two weeks, but it takes a little longer for the swelling to completely subside. It’s also quite normal to experience some numbness in the face. If you notice any signs of infection or experience any bleeding or sudden increase in pain, contact your surgeon immediately.
Recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are usually not noticeable after enough time has passed for them to mature. In any case, they are easily disguised in natural skin creases, by the hair, or, in persistent cases, by makeup until total healing has occurred. Please note that the aging process continues after surgery and that some relaxation of tissues will occur over the first few weeks.
Your surgeon will remove sutures and stitches in a follow-up visit between 4 and 14 days after surgery. Following this, most people are able to resume their normal daily activities (working, food shopping, going out to dinner, limited exercise) without any difficulty.
After a facelift, it is important to follow your surgeon’s instructions carefully. Often, post-surgical instructions include the following recommendations:
- Arrange to have someone to take you home and stay with you for at least 24 hours after the facelift.
- Keep your head propped up to help reduce swelling; sitting up against pillows may be the most comfortable position.
- Arrange your pain medicine prescription in advance, and use as directed.
- Try to avoid irritating your stitches; your surgeon may suggest that you use a gentle baby shampoo or antiseptic shampoo and that you avoid styling products that may cause irritation.
- Return for your follow-up visit to have your stitches or sutures removed.
- Avoid strenuous exercise for at least two weeks following surgery.
- Don’t have facials and other skin treatments for six weeks.
- Use a high-factor sunscreen (minimum 30+ SPF).
Naturally, there are risks associated with any type of operation, and facelift surgery is no exception. Before deciding to undergo any cosmetic surgery, your surgeon should explain the risks posed. These include the following:
- Reactions to the anaesthetic
- Nerve damage (rare)
- Haematoma (mass of clotted blood under the skin)
- Infection occurring as a result of the procedure
- Skin necrosis.
If you are considering a facelift, you should be aware of the risks associated specifically with that procedure:
- Hair loss around the incisions (usually not permanent)
- Scarring: most scars can usually be hidden by the hair (especially in the case of women) or natural creases of the skin, and fade over time.
- Skin Healing Problems (Necrosis)
- Rough skin
- Asymmetry (uneven results in different parts of the face)
- While some slight asymmetry is common, uncommon cases of profound asymmetry may need corrective surgery.
- Nerve damage (nerve damage may be temporary or permanent and can result in numbness to, or muscle paralysis of, part or all of the face).
- With a facelift, there is some risk of injury to the outer branches of the facial nerve, but permanent nerve damage is extremely rare.
- If nerve weakness lasts for more than two or three months, a surgeon who specialises in nerve repair should be consulted.
Please note: that with all procedures there is a possibility of patient dissatisfaction with the outcome.
Allergic reaction to anaesthetic In very rare cases anaesthetics can cause allergic reactions. The best current estimate is that a life-threatening allergic reaction (also known as anaphylaxis) happens during one in 10,000 to one in 20,000 anaesthetics. Your anaesthetist will choose the drugs for your anaesthetic by taking into account many different factors, in particular, the type of operation, your physical condition, and whether you are allergic to anything.
Most people make a full recovery from anaphylaxis. It isn’t known how many anaphylactic reactions during anaesthesia lead to death or permanent disability. One review article suggests that one in 20 serious reactions can lead to death. This in effect implies that the chance of dying as a result of an anaphylactic reaction during anaesthesia is between one in 200,000 and one in 400,000 anaesthetic procedures.
For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.
The reason many people have a facelift is to look younger, and, afterwards, most people do. Facelifts generally make people look about 10 years younger. During the first few weeks after a facelift, there will be some relaxation of facial tissue as your body heals and swelling diminishes.
In general, it is accepted that the younger you are at the time of surgery, the longer the results will last. For a woman in her 40s, the effects may last up to 10 years. For a woman in her 60s, results may last anywhere from five to seven years. It is also important to remember that the way you look after a facelift and how long the results last depends on your:
- Bone structure
- Skin type
- Exposure to the sun
- Lifestyle, e.g. diet, exercise, rest, refraining from smoking and substance abuse, etc.
Most people who undergo facelift surgery are satisfied with their outcomes. However, some people are still concerned about the signs of ageing that facelift surgery does not address: sagging eyebrows, deep facial lines, and fine wrinkles around the eyes or lips. It may be possible to address these concerns after undergoing a facelift. There are a variety of enhancement options available. For example, muscle-relaxing treatments, dermal fillers or laser treatments may be used to help treat fine lines and wrinkles that remain after a facelift.
For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.