Rhytidectomy

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

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The facelift (rhytidectomy) is a plastic surgery procedure most often used to give a more youthful appearance. As it involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping the skin on the patient's face and neck, a facelift procedure is also used in situations in which a tumor of the face might require removal, and to correct the effects of a tumor or malformation that caused stretching of the skin and underlying tissues of the face.

In 2004, the facelift was the fifth most popular cosmetic surgery performed after liposuction, rhinoplasty, breast augmentation and blepharoplasty (eyelid surgery). [1]. Physicians call procedures that provide a more youthful appearance "rejuvenation" surgery, and the facelift is one of the most popular of these. Today, cosmetic surgeons use a number of modalities along with facelifts in facial rejuvenation surgery: lasering of the skin, injection of tissue fillers, and the placement of facial implants (reference:Anderson KW. Baker SR. Advances in facial rejuvenation surgery. [Review] [14 refs] [Journal Article. Review] Current Opinion in Otolaryngology & Head & Neck Surgery. 11(4):256-60, 2003 Aug. UI: 14515074).

The Surgical Procedure

In the traditional facelift, 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.

After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks, chin and neck. At this point, the deeper tissues (SMAS - fascial suspension system of the face) can be tightened with stitches, with or without removing some of the excess deeper tissues.

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.

"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. The areas not well corrected by a facelift incude 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). They are typically performed under general anesthesia or with local anesthesia and sedation.

Well Known Complications and Contra-Indications 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 pre-operative visit.

References and Further Reading

External links

• Introduction to rhytidectomy