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Summary

A facelift is a surgery that can be performed in both men and women to correct the features of ageing such as wrinkles and loose and sagging skin on the face. The procedure is not recommended to those who have poor health or who smoke heavily. In a consultation before the surgery, the doctor will take your complete medical history and will examine the skin on your face and neck. They may also take some pictures to compare the effect of surgery. The procedure takes about two to four hours. You may need to have pain medication after the surgery. Your doctor will ask you to keep the surgical wound clean and avoid any vigorous activities for a while after the procedure.

The operation has a few risks such as infection, nerve damage, and scarring. Your follow-up will be in one to two weeks; however, you should contact the doctor immediately if you have symptoms such as fever, excessive swelling, or bleeding

  1. What is a facelift?
  2. Why is facelift recommended?
  3. Who can and cannot get a facelift?
  4. What preparations are needed before a facelift?
  5. How is a facelift done?
  6. How to care for yourself after a facelift?
  7. What are the possible complications/risks of a facelift?
  8. When to follow up with your doctor after a facelift?

Facelift, also called rhytidectomy, is a surgical technique to make the face look youthful by removing wrinkles (rhytide) and other signs of ageing. 

More and more people are living till old age now due to advancements in medicine and increase in the average lifespan. Wrinkles, age spots, tissue sagging, and effects of sunlight are visible effects of ageing. Depending on the type of skin, the effects may vary. People with thicker skin may have more sagging of the skin due to increased weight of their tissues as compared to people with thinner skin who have more wrinkles and volume loss. As a person gets old, the collagen in their body (a protein that provides structure to the human body) loses its elasticity, and the skin and fat lose their volume, resulting in wrinkles.

Facelift surgery restores the youthful appearance of the skin by making the sagging facial skin firm. The surgery removes excess skin, tightens the deep facial tissue, and smoothens the deep folds to give a younger and enhanced appearance.

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You may opt for a facelift to improve the following features related to ageing:

  • Sagging of the skin and fat at the jawline, also known as jowls
  • Midface sagging
  • Loose skin and fat in the neck region 
  • Melolabial creases (deep creases between the jaw and mouth)
  • Folds, creases, and wrinkles on the face
  • Eye bags, crow’s feet around the eyes, and laugh lines

The relative contraindications (surgery can be performed but with caution) include:

  • If you are on blood-thinning medication for a long time
  • Poor health 
  • Heavy smoking Read more: Effects of smoking on health
  • If you have unrealistic expectations from the surgery
  • If you have fine wrinkles that can be controlled by non-surgical techniques

Read more: Home remedies for skin tightening

The following preparations are needed before a facelift:

  • You will have an appointment with your surgeon in which he/she will note down your complete medical history and perform a psychological evaluation and physical examination to ensure that you are fit enough for the procedure.
  • The surgeon will also carefully examine your skin and its elasticity in the different regions of your face and neck along with the area around your ears.
  • Tell your doctor if you have any allergies or medical conditions along with all medicines you take, including vitamins and herbal supplements; and any previous surgeries you may have had.
  • You may need to discontinue blood-thinning medications like aspirin, naproxen, warfarin, and clopidogrel as they may increase the risk of bleeding during surgery. 
  • Inform your doctor if you have flu, cold, fever, or any other disease in the days leading up to the surgery.
  • The surgeon may also take some 'before' photos for reference to compare it with the after photos of your surgery and see the effects.
  • You may need to stop smoking two months before the procedure.
  • You will need to abstain from drinking or eating anything after midnight the night before the operation.
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The surgery is performed under either local anaesthesia (numbs the area, but you will be awake), with a sedative (a medicine used to relax you), or general anaesthesia (a sleep-inducing medicine).

The method may differ slightly depending on your needs and facial features, but the general procedure is as follows:

  • The surgeon will start making an incision (cut) near your hairline just over and in front of your ear and continue it below the ear, behind it till your hair. 
  • He/she will elevate your skin to get access to the underlying tissue. 
  • The muscle under the skin will be repositioned and tightened, and some of the excess fat will be removed along with the skin. 
  • The surgeon may make a cut below your chin to remove fat and muscles of your neck. This helps in tightening the skin around the neck.
  • Once the excess fat and skin are removed, the surgeon will close the incisions using fine stitches or staples and apply a dressing on the whole region.
  • He/she will place a thin drain at the back of your ear to remove any blood that may pool under the operated skin. The drainage tube is usually removed in one or two days.

The surgery nearly takes two to four hours. 

After the surgery, the medical staff will shift you to the recovery room where you will be kept under observation for a while. Mostly, patients are allowed to go home on the same day of surgery, but some people may get discharged in one to two days.

Take these precautions to care for yourself at home:

  • Take complete bed rest for the first day after the procedure. Do not remove the dressing. 
  • Keep your head raised during the first week, and sleep on your back without putting any pressure on the sides of your head for two weeks. 
  • You can use ice packs on the surgical incisions as it helps in controlling the bleeding. 
  • Avoid activities such as lifting, straining, coughing, or any other vigorous activities that can raise your blood pressure as it can cause bleeding complications. 
  • Your doctor may ask you to take paracetamol every four hours for the pain. If you have severe pain, the doctor may prescribe narcotic painkillers. 
  • Avoid alcohol when you are on pain medication. 
  • The doctor may ask you to take antibiotics to prevent an infection. 
  • Keep yourself hydrated by drinking fluids and have a high-calorie meal that also has a good amount of protein. 
  • It is normal to have some discolouration of the skin, using some moist heat can help to remove it. 
  • Use water and soap to clean the operated site after 24 hours of the surgery three times a day. Pat it dry gently. You may use a solution of 3% hydrogen peroxide diluted in warm water to clean the wound. Apply an antibiotic ointment over it.
  • Avoid going in the sunlight but if you must, use a hat with a wide brim and apply sunscreen.
  • Your doctor may allow you to use make-up after the first week.
  • Avoid saunas and steam baths for some months after the surgery. 
  • You can resume work in two to three weeks after the operation. 
  • Men may need to shave behind the neck and ears as the skin with the beard is shifted.

The facelift provides a visibly improved, youthful and fresh appearance. This increases confidence. The facelift repairs the signs of ageing and makes you look less tired.

When to see the doctor?

Visit or call your doctor if you experience any of the following:

  • Fever of 100°F (37.8°C) or more
  • Excessive bleeding
  • Your sutures come out before they are supposed to be removed
  • Excessive swelling with pressure and pain at the surgery site
  • Abnormal discharge from the wound, such as pus

The risks of the surgery are as follows:

  • Complications due to anaesthesia, including breathing problems
  • Nerve damage
  • Bleeding
  • Haematoma (pooling of blood under the skin)
  • Infection 
  • Persistent pain 
  • Numbness or changes in the sensation at the surgery site
  • Improper wound healing
  • Unpleasant scarring 
  • Seroma (fluid accumulation under the skin)
  • Unevenness of the skin
  • Noticeable or irritable sutures
  • Change in skin complexion
  • Irregular skin shape
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Your follow-up will take place in one to two weeks after the procedure in which the surgeon will remove the sutures. 

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Pourdanesh F, Esmaeelinejad M, Jafari SM, Nematollahi Z. A textbook of advanced oral and maxillofacial surgery. Croatia: InTech; 2016. Chapter 28, facelift: current concepts, techniques and principles; p. 653–680.
  2. American Board of Cosmetic Surgery [Internet]. Indiana. US; Facelift Guide
  3. Warren RJ. Facelift: principles of and surgical approaches to facelift. In: Rubin JP, Neligan PC, eds. Plastic Surgery: Volume 2: Aesthetic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 6.2.
  4. UCSF Health [Internet]. University of California San Francisco. California. US; Facelift
  5. Niamtu J. Facelift surgery (cervicofacial rhytidectomy). In: Niamtu J, ed. Cosmetic Facial Surgery. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 3.
  6. American Society of Plastic Surgeons [Internet]. Illinois. US; Facelift Surgery
  7. Stanford Healthcare [Internet]. University of Stanford. California. US; Facelift - About the Procedure
  8. UR Medicine [Internet]. University of Rochester. New York. US; Facelift (Rhytidectomy)
  9. Cleveland Clinic [Internet]. Ohio. US; Facelift: When to Call the Doctor
  10. Casey Eye Institute [Internet]. Oregon Health & Science University. Oregon. US; Face lifts
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