A facelift, also called a rhytidectomy, is a surgical procedure designed to remove excess fat and tighten the loose skin on the face, neck, and underlying tissues. According to the American Society for Aesthetic Plastic Surgery (ASAPS), 138,245 facelifts were performed in the United States last year. Of that, 124,194 are women between the ages of 35-50.



Who qualifies

A facelift is recommended for those with extremely loose skin, deep lines, wrinkles and jowls. This is why the procedure is commonly performed among those over 35, which is when many start to experience and exhibit a noticeable loss of elasticity in the skin due to the aging process. However, patients should realistically not expect to look like a 20 year old.

A facelift is not for those who want to remove signs of aging from around the upper eyelids. That would be done with a separate procedure called an eyelift (blepharoplasty). However, an eyelift can be scheduled along with a facelift. A forehead lift or neck lift, also two separate procedures, can also be scheduled and performed the same day as the facelift.

While not an absolute contraindication, the risk of postoperative complications is increased in cigarette smokers and patients with hypertension and diabetes, notes Wikipedia. In addition, patients should abstain from taking aspirin or other blood thinners before surgery.

How the procedure is done

A traditional facelift is done under general anesthesia and takes 2-3 hours to perform. However, a facelift can also be done with tumescent anesthesia which has less of the side effects (nausea, bruising) of general anesthesia. While facelift techniques vary, in general, an incision is made along the earlobe near the hairline to conceal any signs of surgery. If need be, a small incision can be created under the chin for additional tightening or removal of facial fat. The skin is then pulled back and separated from the underlying tissue and muscle. Next, the surgeon pulls the muscle and if need be, the underlying tissues upward. He then sutures the muscle to the desired tightness and recovers the area with the skin. In the final stage of the procedure, the skin is pulled upward and the excess skin is cut away. The skin is then sutured or stapled behind the ear, near the hairline.

Common types of facelifts

Although there are several types of surgical facelifts, these are the most common: the deep plane lift or composite lift, SMAS lift, subperiosteal lift/skin lift, mid facelift, and feather or thread lift.

Deep plane lift: Designed for older patients (over 50) with deep folds in the cheeks, nose mouth, jaw and chin. It offers the most dramatic improvement because the deep muscle and tissue under the skin is tightened and repositioned more so than the skin itself. Doctors say this technique is also ideal for smokers.

Composite lift: A deep plane lift that also tightens muscles of the lower eye and upper cheecks.

SMAS (Superficial Muscular Aponeurotic System) lift: Also called the "S-lift," this is great for people who are showing early signs of aging (30s/40s) because a small incision is created in the shape of an "S." Through this incision moderate tightening can be done to the skin of the jowl and neck.

Subperiosteal lift/skin lift: This is a superficial procedure that involves tightening the skin and sometimes the layer below the skin. It is usually done in people who are thin with relatively healthy facial muscles.

Mid facelift: Great for people in their 40s and 50s with beginning signs of sagging or folds in the cheeks and nasolabial (nose to lip) area. Smalll incisions are made around the hairline and in the mouth to lift and reposition fatty areas.

Feather/thread lift: Also called the Aptos lift; it is not for people with excessive sagging. Surgical barbed wire thread is used to lift and pull the tissue below the skin without cutting. The stitch is created at the hairline where it can not be seen. Once the stitch is in, it can be pulled for additional tightening.

Results/Recovery

Immediately after a facelift, the patient faced is wrapped in fluffy, surgical badges. During the time the patient will experience mild to moderate facial swelling and discomfort, which can be managed with medication if necessary. According to the ASAPS, most swelling occurs 24-48 hours after surgery then subsides over the next two weeks. However, it will take a total of four to six weeks for the entire face to heal, during which time the patient should avoid strenuous activity, smoking and extended exposure to sunlight. Over the next several months, the skin may feel dry and rough, but will eventually start to feel better.

It is important to remember, a facelift is considered major surgery. In rare cases, a person might develop a post-operative infection or bad reaction to anesthesia. Other rare, but potential side effects can include: temporary or permanent facial numbness, accumulation of blood under the skin and damage to tissues or nerves underneath the facial skin. Also, a facelift does not reverse the aging process, so in some cases, patients may need an additional facelift in the years to come.

How much does it cost?

According to ASAPS, the average cost of a facelift in the United States is $6,532. Overseas (i.e. Singapore, India), the procedure can cost anywhere from $2,500-4,500.