Rhytidectomy

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A facelift is technically known as a rhytidectomy (literally, surgical removal of wrinkles).

The facelift is a plastic surgery procedure to give the face a more youthful appearance. The goals are to correct sagging facial skin and muscles, to remove excess skin and fat, as well as to restore firmness to create a more youthful, vibrant appearance.

The facelift is a surgical approach to rejuvenate the appearance of the face. In contrast, minimally invasive modalities include Botox, injection of soft tissue fillers, chemical peels, and laser skin resurfacing.

In 2005, the facelift was the sixth most popular cosmetic surgery performed after liposuction, breast augmentation, blepharoplasty (eyelid surgery), rhinoplasty, and abdominoplasty (tummy tuck). [1]

The Surgical Procedure

There are several different methods in performing a facelift. The three basic categories are

  • Skin only
  • Skin plus SMAS (superficial musculoaponeurotic system) work
  • Subperiosteal

Typically, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck.

Skin only

In the skin only technique, after the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (called undermining) over the cheeks, chin and neck. The skin is then pulled upwards and backwards and the amount of excess skin to be removed is determined by feel. The excess skin is then removed and the skin incisions are closed with sutures and staples.

Skin plus SMAS work

The SMAS is a superficial fascial suspension system of the face. In addition to the skin only technique, the SMAS can be tightened with stitches, with or without removing some of the SMAS.

Subperiosteal

The subperiosteal technique involves redraping the deeper tissues of the face over the facial bones. Additional incisions may be necessary in the lower eyelids or in the mouth.

Anesthesia

The facelift can be performed with either awake with local anesthesia or with general anesthesia.

"Good" v. "Poor" Candidates for Facelift Surgery

Facelifts work best in women with thin skin and good bone structure. They are best for eliminating loose skin folds in the neck and wrinkles in the cheeks. [2] The areas not well corrected by a facelift include the nasolabial folds and marionette lines. A facelift leaves long scars. However, the portion of the scars in front of the ear are usually inconspicuous. The scar behind the ear is hidden from casual view. Hair loss in the portions of the incision within the hair-bearing scalp can occasionally occur. In men, the sideburns can be pulled backwards and upwards, resulting in an unnatural appearance. In women, one of the telltale signs of having had a facelift is an earlobe which is pulled downwards and/or distorted. If too much skin is removed (as was common many years ago), the face can assume a pulled-back, "windswept" appearance.

Adjunctive Procedures used in Facial Rejuvenation Surgery

Facelifts are commonly combined with eye lift surgery (blepharoplasty) and skin resurfacing (using chemical peels or lasers).

Well Known Complications and Contraindications to Facelift Surgery

The most common complication is bleeding which usually requires a return to the operating room. Less common (but graver) complications include damage to the facial nerve and necrosis of the skin flaps.

Contraindications to facelift surgery include severe concomitant medical problems. While not absolute contraindication, the risk of postoperative complications are increased in cigarette smokers and patients with hypertension and diabetes. Cessation of smoking before surgery and control of diabetes and hypertension are a part of good pre-surgical planning. Generally, patients abstain from taking aspirin (which interferes with blood clotting) or other blood thinners before surgery. However, since blood thinners are sometimes used to treat serious medical conditions, each patient must discuss his or her exact situation with the doctor at the preoperative visit.