Facelift: Everything You Need to Know and More

As time goes on, the way we look begins to change. We see creases, wrinkles, drooping, and sagging. These are all inevitable and all normal parts of life. However, that does not mean that you have to display signs of aging before your time. If you want to have a more refreshed, more youthful look again, then one opportunity is a cosmetic surgery known as a facelift.

What is a facelift?

A facelift (or a rhytidectomy) is a form of cosmetic surgery that helps give your face a younger, fresher appearance. The goal of a rhytidectomy is to touch up changes in your face that are caused by the aging process. As we get older, the shape and appearance of our face and skin change. Skin becomes looser and fat deposits increase in some areas of the face and decrease in others. A facelift can improve:

• The sagging appearance of your cheeks
• The deepening of the skin crease that goes from the sides of the nose to the corners of the mouth
• The excess, drooping skin on your lower jaw line (jowls)

However, patients must be realistic when going into the surgery so as to not be disappointed afterward. Though a rhytidectomy can rejuvenate your facial appearance in many ways, there are certain things that it cannot do:

• Decrease fine creases or wrinkles in your skin
• Eliminate sun damage
• Treat irregularities in skin color
• Fundamentally change your appearance
• Stop the aging process

Who is the best candidate for a facelift?

Typically, patients getting a facelift are between 40 – 60 years old, because this is when signs of aging usually appear. However, people who are younger or older can also participate in the surgery. Generally, anyone who is physically and mentally healthy and a non-smoker can get a rhytidectomy. However, the most important criterion is that the patient has realistic expectations regarding their results and the surgery as a whole.

Furthermore, if you fall under any of these categories, it is not recommended that you get a facelift:

1. If you take any blood-thinning medications or supplements – this can increase your risk of a hematoma after surgery because they affect your blood’s ability to clot.
2. If you have certain medical conditions – these include conditions that prevent blood clotting, diabetes, and hypertension. Conditions like these increase your risk of a hematoma and heart problems and can cause your wounds to heal poorly.
3. If you smoke – this increases the risk of a hematoma, skin loss, and poor wound healing.
4. If your weight fluctuates often – frequent weight loss and gain can affect the result of your surgery. This is because weight changes can change your face shape and skin condition.

Types of Facelifts

There are multiple types of facelifts, each differing in the area of the face that they focus on and on their degree of invasiveness. Furthermore, everyone’s face shape and skin condition are different, so not every type will be appropriate for every patient. During your consultation, you and your doctor will discuss which type of facelift is right for you.

Traditional Facelift

The traditional facelift is the most common type of facelift and is usually recommended for those who want to improve signs of significant aging. During this procedure, your skin is separated from the tissue underneath and the muscles and supporting structures of your face are tightened. Excess fat is then removed and your skin is repositioned in a natural way. The surgeon will then remove any excess skin and then suture the incision closed.

SMAS Facelift

A SMAS facelift (or a superficial musculoaponeurotic system rhytidectomy – the muscular layer) deals primarily with the lower two-thirds of your face. Here, your muscles are tightened, and then excess skin and fat in your cheeks and lower face are removed.

Deep Plane Facelift

In this type of rhytidectomy, the SMAS, fat, and skin of your face are lifted at the same time as a single unit.

Mid-Facelift

A mid-facelift focuses on your cheek area. Your surgeon will reposition the fat in your cheeks and tighten the skin in that area.

Mini-facelift

This type of facelift focuses on the lower part of your face and your neck. It is less invasive and quicker than the other types of facelifts and is usually recommended for younger patients.

Cutaneous Facelift

This type of facelift focuses on your neck and the lower part of your face. It also only involves your skin and not your muscles.

Facelifts: A Step-by-Step Process

Below is a step-by-step walkthrough of each part of the process of getting a facelift:

Consultation

The consultation is the time for you and your doctor to discuss the procedure, the predicted results, and make decisions on things like the type of facelift you will be doing or the kind of anesthesia. This is also a time for your doctor to ask you questions and do a few preliminary tests to make sure that you are a good candidate for a facelift. During a consultation, your surgeon will:

• Ask questions about your medical history
• Review the medications that you are currently taking and their dosages
• Conduct a facial exam that will include: taking pictures of your face and examining your bone structure, face shape, fat distribution, and skin condition
• Evaluate your physical and mental health

However, this is also the time for you to ask your surgeon questions, as well. Be sure to ask about things like their credentials and their experience and anything you might want to know about facelifts. In addition, it is also a good idea to ask them for pictures of their previous patients and how they looked after surgery.

Preparation

In the days leading up to your rhytidectomy, you will have to do a number of things in order to make your surgery as easy as possible.

• Get a blood test or other medical evaluation
• Take certain medications
• Adjust or stop your current medications (such as aspirin or some anti-inflammatory drugs)
• Wash your face and hair with germicidal soap
• Stop smoking

Also, it is recommended that you arrange a part in your house to help you through recovery, as well as have someone stay with you for at least the first two days after surgery. It is recommended that your home recovery area has:

• Gauze, clean towels, washcloths
• Ointments or creams, as recommended by your doctor
• A thermometer (to check for a fever)
• Materials for entertainment (books, games, etc.)

In addition, you should not eat after midnight the night before your facelift.

The Facelift

Facelifts usually take about two to four hours to complete, but the procedure might take longer if you choose to do other cosmetic surgeries (like a neck lift) at the same time. Also, be sure to arrange for someone to drive you home after surgery. Facelifts are done in three stages:

Anesthesia

Before surgery, you will either be put under local anesthesia or general anesthesia. You will discuss which one you will use beforehand with your doctor. Local anesthesia means that you will be awake for your procedure and the anesthesia will only numb the area your surgeon is working with. General anesthesia is when you are completely asleep for the procedure.

Incision

During a facelift, your surgeon will pull back a section of your skin and alter the placement of the tissue below to give your face a more youthful shape. Excess skin is then removed before suturing the flap closed. In addition to a facelift, many patients also opt for a neck lift (platysmaplasty) to reduce the sagging skin on the neck.

The placement of the incisions will differ based on the type of rhytidectomy you get. However, in general, your incisions could be placed in any of these places:

• Around your ears
• At your lower scalp
• In your hairline
• In your mouth
• Under your chin

Closing the Incision

There are three ways to close facelift incisions:

• Dissolvable stitches
• Skin glue
• Stitches that will be removed

After the Facelift and Recovery

After the surgery is over, you will be taken into a room for observation until you are stable and ready to leave. At this time, your incisions will be covered with bandages. This adds a little bit of pressure to the area to help minimize bruising and swelling. You might also have a small tube placed under your skin or behind one or both of your ears to drain excess blood or fluid. Your surgeon will then give you specific instructions for your recovery, and schedule a follow-up appointment.

After you get home, for the first few days you should keep your head elevated and take any pain medication that your doctor has recommended. Above all, relax in the recovery space that you set up before your surgery. In these few days after surgery, you may experience mild pain, drainage from the incisions, bruising, swelling, or numbness, but all of this is completely normal.

In addition, you will need to take off work for a few days to recuperate after surgery. For less invasive types of facelifts (ex. the min-facelift), you will need to take between five to seven days off of work. More invasive ones (ex. the traditional facelift) will cause that time period to extend to three weeks.

Contact your doctor if you experience:

• Chest pain
• Irregular heartbeats
• Severe pain on one side of your face or neck within the first 24 hours after surgery
• Shortness of breath

Self-care after the Facelift

Over the first three weeks, be sure to relax and take care of yourself. This will aid in your recovery and help minimize the risk of complications. Be sure to:

• Follow the recovery instructions given to you by your doctor on the day of the surgery
• Follow your doctor’s instructions on when you should begin using shampoos and soaps
• Wear clothes that fasten in the front as opposed to those that you need to pull over your head
• Do not pick at scabs that may develop on your wounds
• Avoid using makeup
• Avoid pressure or motion on and around the incisions, and any vigorous activities
• Do not color, bleach, or perm your hair for at least six weeks
• Avoid direct exposure to sunlight and use sunscreen when going outside

Follow-Up Appointments

After your surgery is over, you will be required to visit your doctor a few times afterward for follow-up appointments. Your schedule will probably look something similar to this:

1. The Day After: your surgeon will remove your drainage tube first. Then, he/she will apply some antibiotic ointment to the sites of your incisions. Finally, your bandages will be replaced and you can go back home.
2. Two – Three Days After: you will switch from bandages to an elasticized facial sling.
3. A Week After: your stitches will be removed and your surgeon will check all of your wounds.

Any subsequent appointments will be scheduled by you and your doctor so that they can assess the results and see how your recovery is progressing.

Risks and Complications of Facelifts

As with all surgeries, facelifts have risks and complications that might arise after surgery. Some common complications include:

• Anesthesia risks
• Cardiac and pulmonary complications
• Deep vein thrombosis
• Facial nerve injury with weakness
• Fluid accumulation
• Hematoma (blood clotting in the surgical area)
• Infection
• Numbness or other changes in skin sensation
• Pain
• Poor wound healing
• Prolonged swelling
• Scarring
• Skin irregularities and discoloration
• Skin loss
• Temporary or permanent hair loss at the incisions
• Unsatisfactory results which may include asymmetry, surgical scars, and visible deformities at the ends of the incisions

Additionally, please contact your doctor if:

• Any abnormal discharge coming from your incision sites (like pus)
• Excessive bleeding that comes through your bandages
• Extreme
• Extreme swelling
• Fever
• Your sutures coming out before you’re scheduled to have them removed

Frequently Asked Questions (FAQs)

How much does a facelift cost?

The cost of a facelift depends on your surgeon’s experience, the type of procedure, and the office location. However, on average, a facelift will be around $8,000. This, however, is only part of the overall fee. Other related costs include:

• Anesthesia fees
• Medical tests
• Medication costs
• Surgeon’s fees
• Surgical facility costs

Are facelifts covered by insurance providers?

A facelift falls under the category of cosmetic surgery, and therefore, an elective surgery. Because of this, most insurance providers do not cover facelifts or any complications that might arise.

What other surgeries are typically done alongside facelifts?

Sometimes, in order to fully and harmoniously rejuvenate the face, other surgeries will be done alongside the facelift. These include:

• Brow / forehead lift
• Eyelid lift (blepharoplasty)
• Facial implants
• Jaw line rejuvenation
• Laser skin resurfacing
• Nose job (rhinoplasty)

How long do the results of a facelift last?

The results of a facelift are not permanent and cannot stop the effects of aging after the surgery. Skin will begin to droop again and signs of aging will reappear. Typically, facelifts last for about 10 years.